LETTER: A sick system

With insurance your prescription is $10; without it, $210. That’s sick. In fact, the entire healthcare system is sick. It suffers from inexcusable inequities. It needs to be changed.

People used to pay for medical services out of pocket. When health insurance first became available in the 1920s, patients got reimbursed by the insurer, but eventually insurers arranged to pay a group of care providers directly, leaving the patient out of the loop. Soon insurers were negotiating beneficial rates for services, but unless the patient used a specific provider, only a set amount was allowed. When government froze all salaries during World War II, employers began offering employee health care as a benefit to get around salary caps. Now, it dominates the market and the cost disparity between the insured and non-insured is ludicrous and tragic.

I recently spent 10 days in the hospital, the victim of an auto-pedestrian hit-and-run. My raw bill was more than $100,000. Insurance negotiated that cost down to $13,000.

Medical expenses are the most common reason for bankruptcy filings in this country.

How do we fix it? Adopt government health care?

The government helped create this mess; the only way out is free-market economics.

If the state wants to help, it should ensure that market is fair. Insurance should be a true risk pool. The concept is basic. The solution is obvious: Drug and healthcare providers must charge all customers the same, whether insured or not. They can charge whatever they like but must publish their rates for each product, procedure or service.

Insurers may also charge whatever they like and offer a menu of coverage options (maternity for males?). They must publish their rates and charge all clients the same, but co-pays can range from 0 percent for clients who have been covered by insurance (including other insurers) since birth to 99 percent for those who enrolled just yesterday. Those who have a long lapse in coverage may opt to pay a catchup surcharge until they reach a target percentage. Those not currently insured may have to pay pre-existing condition surcharges. The insurer may reduce premiums in return for a variety of deductibles and/or additional voluntary co-pays.

Make insurance a real risk pool instead of a crap shoot. Incentivize participation.

Except for the indigent and disabled, medical debt should be equivalent to a debt owed to the IRS. The indigent and disabled would fall into the safety net, but that’s a tax issue worthy of a future letter.

Jack McNally, Harlingen

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