Elmo Band-Aids and Other Ideas: Health Care Reform from the Bottom Up

The family finance website, FiLife is sponsoring a contest called “Fix U.S. Healthcare In Just Three Words.” Never mind that FiLife uses seven words to let us know about it! To enter the contest, you can submit a phrase via your Twitter account such as “Impeach Barack Obama” or “Hogtie Insurance Executives.” My favorite would be “More Elmo Band-Aids.”

Actually, the contest is a great idea. Much better than town hall meetings commandeered by lunatics. I hope FiLife publishes the submissions in a list and legislators take a look. Because health care reform has locked itself in a cage. The process of delivering health care legislation no longer returns the comforting stench of sausage-making and now more closely resembles a UFC event in the proverbial Octagon.

Just as the political response to the financial crisis threatens to leave intact the existing system of interests and incentives within the banking system, powerful interests (insurance companies, drug companies, the hospital industry) have captured the health care reform process and virtually guaranteed that whatever solution emerges will increase costs without materially changing the structure of the industry. We may get more coverage for the uninsured, which is good, but insufficient to address what truly ails health care in the United States.

What truly ails health care in the United States is that insurance companies and the government are embraced in a pas de deux that excludes citizens, the consumers of health care. What consumers of health care — you and me — lack, as a result of this strange shuffle of the two dancing bears is information, authority, and responsibility we need to make intelligent, meaningful choices about the care of our bodies and our minds.

I don’t “Tweet.” Thinking about Twitter sets off strobe lights in my brain and triggers epileptic fits. But if I did “Tweet,” I would submit the following suggestion: “Make costs transparent.”

Recently, Whole Foods CEO and Loose Cannon John Mackey exposed the contradictions between the “progressive,” health-oriented values of the Whole Foods brand and the underlying realities of its own health-care costs in an incendiary Wall Street Journal opinion piece that aroused the ire of the affluent patrons of his stores.

Mr. Mackey’s mistake was to criticize the premise of “Obamacare” — that government offers the solution to the health care mess. I believe this is a fair statement of the premise of Obama’s health care reform position. And it is not an unreasonable premise from which to start the debate. Obviously, government must play a central role in the reform process.

However, Mackey makes some provocative points — the most interesting being that a powerful set of non-governmental solutions also exist. On this list, one might include: 1) significantly higher deductibles in combination with tax-free employee savings accounts to cover the cost of the deductible; 2) transparent pricing so consumers can make informed decisions; and 3) more emphasis on prevention of illness rather than treatment of illness (Mackey, less delicately, basically said no more subsidies for overweight and otherwise lifestyle-challenged people).

In a longer and more nuanced article in The Atlantic, entitled “How American Health Care Killed My Father,” David Goldhill also tallies up a long list of nongovernmental ways to reform health care. Again, making health care information transparent and placing consumers at the center of the process — so that health care providers have to respond to the needs of people, not the needs of a government bureaucracy — top the list.

In both cases, Mackey and Goldhill are essentially telling us that we must reform how we imagine health care — so that it is less mysterious and opaque, so that we, as individuals and families, can take responsibility for our decisions. Health care is not an unlimited entitlement, they are saying. It will be rationed. The only question is whether we do the rationing ourselves, or the government and insurance companies do it for us. But if we create a culture of self-rationing, the health care system will have to respond to our needs, making choices and decisions less stark and frightening.

So let FiLife know how you would fix U.S. health care. Vote for Elmo Band-Aids!