Pass the Prozac...a mildly cynical view of the future

To state the obvious, one of the pressing issues facing the American economy is the spiraling increase in healthcare costs. All forecasts that I have seen are pretty grim, essentially projecting an unremitting increase in demand, coupled with increasing costs in delivering care.

So far, every solution that has been tried has ultimately failed. PPO plans, by steering patients to providers with pre-negotiated prices, were invented to provide a lower cost alternative for indemnity plans. HMO plans included still more constraints, with the idea that the gatekeeper system would reduce unnecessary utilization and reduce costs still further. Somebody forgot, however, that low copays attract heavy utilizers. Today in California, many HMO plans are more expensive than the PPO plans. So much for Plan B.

The latest trend is to Consumer-Directed Health Plans, a polite euphemism for cost-shifting from the employer back to the consumer, with the aim of encouraging the consumer to make cost-effective health-care decisions. The underlying assumption, of course, is that the consumer has both the ability and willingness to make cost-effective decisions...an assumption, based upon the consumers that I know, I view with extreme skepticism. Consumer-driven health plans also fail to address any of basic cost drivers in the system: the rights of illegal immigrants of procure subsidized care; the large ranks of the uninsured, to whom a high-deductible or consumer-driven health plan is about as attractive as anesthesia-less colonoscopy; the pricing of prescription medication by their "“economic value"” as opposed to the cost of research and production; the rise of large hospital chains with geographic near-monopolies; and last, but not least, the general aging of the population, complicated by modern medicine's ability to extend the lifespan of the aged infirm almost regardless of cost and resulting quality of life.

No, the picture isn'’t very pretty, but I, with apologies to Jonathan Swift, have A Modest Proposal. Almost all insurance policies, with the exception of HMO's, which can, of course, be modified, have a lifetime maximum benefit amount. Up until now this has been impossible to enforce. Simply by changing insurance companies or jobs, the old information vanishes into the ether and the accumulated draw against your lifetime maximum gets reset to zero. This, however, is about to change. There is a concerted effort to implement electronic databases containing one's entire medical history. For the first time, we will truly be able to determine who the heavy users are of medical services and take appropriate action to stop this drain on societal resources. A lifetime max can truly be a lifetime max. When you hit it, you hit it... Let'’s just say that it gives a whole new emphasis to the concept behind consumer-driven health plans.

Just think. Finally there will be a true incentive to exercise. To diet. To stop smoking. Just don't overdo the jogging. You don'’t want your knees to wear out. Replacing them is expensive.