The Patients' Bill of Rights has moved to the back burner on
Capitol Hill because of priorities such as closing our wide-open
borders and stopping visa approvals to terrorists. The Senate and
House have passed different versions of the bill, which have yet to be
resolved, but only the House bill (H.R. 2563) contains a provision that
offers real hope to reform our health care system.
We don't need more government funding or regulations. We need
more choice, more competition, and allowing individuals to own our own
health insurance in the same way we own our automobile insurance.
The Medical Savings Account (MSA) provision in the House bill is
the approach that can simultaneously address the problems of high
costs, increasing numbers of uninsured, and prescription drugs. MSAs
will also solve the problems of access, affordability and portability.
The MSA is an individually owned tax-exempt medical savings
account used in combination with a high-deductible, catastrophic health
insurance policy. The account is used to pay for routine medical care;
when expenses exceed the annual deductible, the catastrophic policy
kicks in to pay the remaining medical bills.
MSAs can be spent for all medical expenses, including drugs,
dental care, and eyeglasses. There are no restrictions on choices of
doctors, specialists, hospitals, or tests.
MSAs allow individuals to make their own health care decisions
without checking with a gatekeeper, a primary physician, or a
bureaucrat. All those fearsome words that came into our vocabulary
during the Clinton health plan debate will disappear: gatekeepers,
capitation, HMOs, and bureaucrats making medical decisions.
The money left over at the end of each year accumulates in the
MSA, drawing interest and building lifetime savings that can be used
for later expenses such as long-term care.
Most Republicans who were elected to Congress in the big victory
of 1994 pledged to pass MSAs. All they gave us was the pitiful shred
of an MSA program that was tucked in the Kennedy-Kassebaum law of 1996
(the Health Insurance Portability and Accountability Act, or HIPAA).
The Kennedyites in the Senate planned for MSAs to fail by
encrusting them with all sorts of complicated restrictions on who can
qualify, who can contribute, and what are the limits for the
contribution and the deductible. These restrictions have no rational
basis except to discourage people from using MSAs, which was the real
goal of those who hope that public dissatisfaction will promote the
adoption of a nationalized health care system.
Each time the liberals made a major attempt to enact a national
health care system -- in the 1930s, 1940s, 1960s and 1990s -- the
American people rejected the concept of socialized medicine as
incompatible with the American way of life. Nevertheless, the liberals
plowed ahead with their incrementalist strategy of folding one group
after another into a government health plan.
In 1929, only 14 percent of health care expenses were paid by
government and 86 percent by private funds. By 1998, 46 percent of
health care expenses were paid by government and only 54 percent by
Government programs always end up costing many times what their
sponsors predicted. Payroll taxes to fund Medicare Part A (hospital
insurance) have increased 36 times (26 increases in the applicable tax
base and 10 increases in the tax rate).
Nevertheless, Medicare is now facing bankruptcy. Government has
no remedies except higher taxes, price controls, adding more costly
benefits, and even rationing.
The biggest factor in health care costs is the dramatic expansion
of third-party payments, and that in turn is aggravated by the
government's increasing role in health care. If people don't care (and
often don't even know) how much is spent because someone else is paying
the bill, there is no incentive to shop around, question costs, or
avoid unnecessary tests or treatment.
MSAs solve the problem of third-party payments by MSAs restoring
the relationship between buyer and seller (patient and provider) so
that patients can check prices and make their own decisions about
whether and whom to pay. When people are allowed to keep their money
they don't spend on health care, they can be counted on to keep costs
Finally, MSAs will end the current discrimination in the U.S. tax
code that permits big businesses to deduct all the money they spend for
their employees' health insurance (including "gold-plated" policies for
top executives), while individual workers are denied that same tax
Tell your Member of Congress to make sure that the MSA provision
passed by the House is included in the final bill, giving patients a
real Bill of Rights.