70% of all health-care costs are the direct result of behavior. 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.

Are there good examples of countries who have a single payer plan which provides rewards based on behavior? Choosing to receive a reward should require that the recipient agrees to non-invasive monitoring by friends and family. If I catch you smoking, I get your reward and you get penalized.

Scott Harrington writes…

Safeway’s program offering employee premium discounts related to tobacco use, weight control, blood pressure and cholesterol levels is a good example.

Financial incentives for healthy behavior have the potential to significantly reduce costs without reducing quality. A failure of health-care reform to permit or incorporate such incentives would make coercive government measures to control costs more likely. These controls might include limits on provider reimbursement, comparative-effectiveness or cost-benefit criteria that must be met for care to be reimbursed, or budget caps. The results would be less health–more obesity, diabetes, heart disease, and cancer–and eventually less health care.

An aversion to having health-insurance rates and coverage linked to individual behavior may be on the verge of becoming national policy. If that happens, the unintended consequences could be very costly.

I expect the quality, convenience, timeliness and freedom of my health care to decline under a government-run plan, and its costs to increase. That is because there is only one thing that government brings to the table on any issue that private systems cannot, and that is a monopoly on the legal use of force to compel submission to its wishes. How could that possibly be a desirable attribute of any health care system?

Government-run health care will eventually -

Be operated entirely by unionized employees. Union contracts protect the worst employees and drive off the best. When unions negotiate with politicians for their contracts, the tax-payers and the public who depend on public services become nothing but deep pockets and hapless victims, often not even having a place at the bargaining table if the politicians were put in place with union money, as they often are. The unions have destroyed our car industry, our schools and are bankrupting some of our biggest and (formerly) richest states. Unions and high quality affordable customer service are simply incompatible with each other in the long run.

Make all but the rich and the political elites subject to the whims, fads, prejudices, and corruption of a political bureaucracy. Already, insurance plans are rendered far more expensive than necessary because politicians mandate coverage at the behest of lobbies and anti-science health cultists, and against the wishes of the plans’ customers. Politicians have forced my plan to include coverage for acupuncturists, naturopaths, chiropractors, mental health counselors, and others, not because members of the plan wanted that, but because lobbyists for those groupsd donated heavily to the Democrats who run my state. Naturally, I’m forced to pay for worthless (to me) coverage.

Give the government a financial incentive to terminate the lives of more “expensive” citizens and to limit the health care available to unpopular minorities (or majorities) like the obese, smokers, carnivores, the political out-party, and anyone who doesn’t graciously submit to its demands. What is to stop the government from limiting your health care if you refuse to sign a “living will” authorizing the withholding of treatment? What is to stop the government from requiring that you undergo “counseling” if you want to aggressively fight an illness that the government would rather you give in to, until you agree to what it wants? Right now, if my doctor doesn’t support my choices, I can find a different one. A government-run system simply cannot allow that, any promises it may make now to the contrary.

Not to mention that nothing in the U.S. Constitution grants the government the authority to take over such an intimate area of its citizens’ lives.

A government-run health care system will eventually end up being as dysfunctional as the D.C. public school system, except that you will not be allowed to drop out and you will never graduate from it. There will be no escape. And the costs will end up, as with all major government entitlement programs, vastly exceeding current projections.

Government creates a big demand (via Medicare, Medicaid, CHIP) but no supply
Government forces hospitals to treat those who do not pay including illegals if they show up at the emergency room
Government allows lawyers to sue doctors for possible but adverse outcomes regardless of negligence and prevents patients from contracting with doctors with a promise not to sue
The FDA increases costs of medications (via various means I won’t get into here)
State governments specify what insurance must cover so males pay for pregnancy, non-smokers pay for smoker’s illnesses, viagara is covered, etc
The federal government prohibits employers/individuals from purchasing insurance across state lines

The solution is not more governmental meddling in the free market. Medical care used to be so inexpensive that doctors actually made house calls. Not any more.

This is the absolute truth of the whole health issue. You must ask yourself as a citizen what this is worth to you. And also you must ask yourself whether our leaders’ actions will result in genuine, practical, beneficial results.

Educate yourselves fully and don’t rely on soundbites from talking heads. Our whole philosophy on this issue stems from an improper assumption. It is the assumption that money must some how be a limiting factor in providing health care.

There are other ways in which “costs” can be covered. And If we are creative we can find solutions.

In imperial China some doctors would open clinics that offered general care to the community which supported it. Doctors would provide service to the community as needed. If while following doctors orders, one were to become ill, then the ill patient was freed of the obligation to pay the doctor until the doctor made things right.

This arrangement encouraged the doctor to provide sound medical advice and preventative care, and gave the community a sense of control over the quality of care. The clinic was regarded as a community asset, and the community was the life of the clinic.

Perhaps hospitals, clinics, and other such providers should be required to garner support in this fashion.

Just an idea. It would be good to explore other ideas where money is not the central focus.