To: patron_anejo_por_favor who wrote (224690 ) 3/1/2003 2:58:51 PM From: ild Respond to of 436258 From Carl Swenlin WELCOME JOHN MAULDIN READERS John was kind enough to mention our site in his letter, and we would like you to give you a free peek at the core content. You can try the PRIME web site and the Decision Point Alert newsletter free for a few days using the following access codes: UserID: linear Password: trends RISING HEALTH CARE COSTS If you are not reading John Mauldin's free weekly column on www.2000wave.com you are missing out on some of the best perspective on the economy available anywhere. I personally consider it to be required reading. Last week John wrote about the rising cost of health care: It has nearly doubled in the last 10 years, and it is expected to nearly double again by 2012. I wrote the following in response to his article. * * * Regarding the rising cost of health care, certainly new drugs and technologies are part of the cause, but, then, I have to ask why it is that the cost of technology and products in other areas of the economy are not increasing at such an alarming rate, and are, in some cases, actually declining? I'm inclined to believe that it has more to do with the fact that the customer (patient) is not involved in negotiating price with the provider (medical facility). The insurance companies are interfering with the basic market forces that would tend to keep prices competitive. To the patient, the insurance company is the provider through which he gains access to the medical facility. To the provider the insurance company is the customer, and the patient a necessary inconvenience. The architecture is just plain screwed up. In December I spoke with a friend who processes insurance claims for a medical group. She described a conversation she had with her insurance company counterpart, the subject being how many treatments a patient should be receiving for a particular ailment. I noted that neither the patient nor the doctor was involved in this conversation -- just two accounting-types fighting over money. Insurance companies are increasing the cost of medical care, and at the same time undermining the quality. There is also the Socialistic nature of the health insurance system that guarantees that it will fail, as all Socialist programs must ultimately fail. About 30 years ago, when HMOs were just emerging, I remember reading an article about them. I thought, "Wow! For only a few hundred bucks a month you can get unlimited treatment for your whole family. Can this possibly work?" The answer, we now see, is no. Imagine that employers could provide a similar benefit for, say, Walmart. The employer pays Walmart a set amount per month, and the employee and his family can go to Walmart as often as they want, and carry out as much merchandise as they want, only paying a $10 co-pay at the door. How long do you think this would work? Five minutes? Granted, Walmart is a slightly bigger magnet than the local medical clinic, which is why it will take longer for the current medical insurance system to fall in a ditch, but fall it will, because the patient, the person driving the cost, isn't making decisions regarding cost. The patient is getting virtually free health care. Not to worry, though, the politicians will step in and give us Nationalized Health Care. Of course, this is just the insurance company version of health care without the profit motive as a deterrent to higher costs. And, with bureaucrats running the show, watch for the groundbreaking ceremony for the new Soilent Green Wing at your local hospital. Is there an alternative? Yes, but we have to begin with the concept that there is no free lunch. This is an irrevocable law of nature that must be accepted at the beginning of any program. Eventually somebody has to pay. If it appears to be free, you're not looking far enough down the pipeline -- there's an invoice down there somewhere. What I think might work is to shift medical insurance toward major medical coverage only. Begin with a large deductible for routine medical problems, and use medical insurance as protection against being wiped out financially by major illness. This is the way a lot of people, who are not covered by employers, are already dealing with it today. Fixing the tax code would help as well. One of the real inequities is that some people get tax free health coverage through their employers, while others must pay for their insurance and care with after-tax dollars. While I think that we can fix the health care system, I don't think we will, because big bullets will have to be bitten by too many people. It is easier to forego the hard choices and blissfully believe that this time the lunch will really be free. You know, like Social Security.decisionpoint.com