Medicare for all!  That seems to be the chant from the folks who push the idea of the Healthcare law, unaware or perhaps uncaring that Medicare will now go bankrupt in twelve years. Doctors are leaving the medical profession at a staggering rate, and fewer are accepting Medicare patients. Yes, this all seems to be working perfectly; what could go wrong?  Sarcasm aside, colleges are churning out future doctors, who say things like “Medicare reform is going to bankrupt seniors because of pre-existing conditions” and “Without the pre-existing conditions clause, women will have to pay more for prenatal care.”  These actual statements from highly intelligent individuals, reveal the bias of our educational system and political dialogues.                 

Insurance at its most basic level, is a gamble.  We pay a premium similar to an ante in a poker game, and then keep paying in.  If we don’t get sick, don’t get in a wreck etc. the house wins.  When we get into a wreck, or become sick, we get a “payout” for services rendered. Vegas and insurance companies have a major business practice in common in the sense that they are in the game of “managed risk.”  

Keeping our vegas scenario going, to add the new changes that are part of the Affordable Care Act would be like the Bellagio allowing players to bet after the cards are revealed, dice are thrown, the wheel is stopped, etc.  It would be almost impossible for the house to make a profit, which would also make it impossible to “pay out” when a customer is sick. Well who is in the business of being unprofitable?  The government, and that’s the point; Medicare for all. Politicians are talking about how the rules of the game should be structured, when they really should be helping us walk away from the table.  Most people view insurance as a savings system, instead of seeing insurance for what it truly is.

                 The aforementioned thoughts of many misguided Americans do however have some merit, thus making them more dangerous. No one can deny that pre-existing conditions are increasingly being used to deny coverage and rates are continuing to increase. Unfortunately there are several items that haven’t received as much attention and debate; real reforms which could truly address the systemic problems with the healthcare industry. 

                One of the best ideas to truly address the pre-existing problem of insurance comes from Sens. Rand Paul and Mike Lee.  Anyone who has listened to Dave Ramsey has heard of Term-Life insurance, which has a set premium for a set term.  Term-life has revolutionized the life insurance industry and offers affordability and security to many Americans who normally would be far less prepared for an unexpected death. Bringing a cheaper affordable “term” type option to the health insurance industry could address many of the claims of pre-existing conditions and ensure citizens would have accesses affordable insurance independent of their employer.

                Another idea is the concept of direct care.  Direct care is essentially a time-warp before wide spread insurance, when doctors made house calls and were more accessible to the local community than they are now.  There are many concepts behind Direct Care but the most promising one structures Primary Care like any other membership. One would pay a set monthly or yearly rate and that’s it.  The benefits are numerous including lower doctor overhead, lower wait-times, and a likely increase in Primary Care Physicians, something which has dropped significantly over the past fifty years.  Most of all this empowers the patients, makes them more aware of actual costs, and allows the physician to focus on medical care, not aspects of a business.  

Finally, there is a system that is in place but is frequently ridiculed, the Health Savings Account.  The HSA can be very powerful if properly utilized and transforms insurance into a true savings concept.  Imagine if instead of the money placed into your current insurance plan, you place that same amount into a savings plan to be used to cover health expenses.  Now imagine the amount of money that would grow should it be matched by or funded by an employer.  Some detractors claim that when medical costs exceed thousands and maybe millions of dollars this is “unrealistic.” Fair, but many of these detractors are the same ones who state that we can spend a trillion dollars, not add one new doctor, cover millions more people, and not increase health costs through Obama care. 

The proponents of the Affordable Care Act won’t be concerned until our healthcare resembles Britain, with hospital patients drinking from potted plants just for a little water and ambulances treating ER patients in the parking lot just to fudge the wait time numbers. We are being faced with a decision that is at least five thousand years old, accept and choose freedom without certainty of outcome, or willingly embrace slavery for the security it brings.  Those choosing the latter are the growing minority and come November could very well be the majority. 

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