Health insurance is in crisis mode.  Incoming president Obama has called for input from private citizens, and this seems like a good time to make a fresh start. As a practicing MD in the US, and having practiced 15 years in the Canadian Health Care system, I have seen both sides of this argument. 

Our current US model is a catastrophe.  Over 40 million Americans have no insurance, and many of the rest are “under-insured”.  That means they are disqualified from any care relating to “pre-existing” conditions.  Or, they have large deductibles that still mean they have to come up with cash for medical visits; if they don’t have the cash available, they postpone or cancel medical care.  Many insured  patients will postpone their screening tests, such as colonoscopy, mammograms, biopsies of moles etc., because they can’t come up with the cash, and are forced to gamble that they do not have an early cancer forming.

We currently have a “Reverse Robin Hood” system.  Instead of doctors and hospitals accepting full payments from the wealthy, and scaling down to being paid in eggs or live chickens from the poor, the modern system charges FULL dollars to the uninsured, but gives those with insurance a HUGE discount.  So if you are wealthy, and have your ruptured appendix removed, you might see a hospital bill for twenty thousand dollars.  But you will note that a huge discount has been arranged with your insurance carrier, so the hospital writes off the difference, and you can walk away.  If you are uninsured, however, the hospital will offer NO discounts, and will go after you even if it means taking away your house.  Very disfunctional.

So here is a solution that already works, taken directly from our other major insurance; the automobile.

Auto insurance has two categories:

1. Bad Luck (Standard Insurance); This covers you if you are hit in a parking lot, pelted by hail, or have an accident on normal streets.   It does not cover risky choices; for these see the following category… 

2. Bad Choice (High Risk Insurance):  Routinely available for all entries in a demolition derby,  NASCAR event, or the Indie 500.  Also available (at premium insurers such as Lloyds of London) for those who want to jump their car over the Snake River Canyon. A full menu of prices is determined by the level of risk, determined by the insurers. 

Note that one can still insure the high risk scenario, but it is a lot more expensive than regular street insurance.

See how this would simplify medical insurance:

1. Basic “Bad Luck” insurance: all cases where the patient is a victim are covered.  This means the child with leukemia, the woman  with breast cancer, the elderly with a broken hip and all cases of infectious diseases are completely covered.  Considering these cases are in the vast minority, this insurance would be extremely cheap, and could be made universal.

2. Supplementary “Bad Choice” insurance:  covers all cases where the patient is an accessory  to their health problem.  This means the 400 pound thirty-year old will not be able to count on a free ride at the cardiac ward unless they have purchased this extra insurance.  Nor can they expect a free gastric bypass operation without it.  Type 2 Diabetes from the usual self-induced cause of overeating/obesity?  Not covered unless you buy this supplemental insurance.  The chain smoker cannot count on a free lung transplant, unless they have paid their premiums for this plan.   For that matter, anyone choosing to leave off their seat belt (and instead electing to use their face as an air-bag) would need this supplemental “high risk” insurance to cover their care.   Same with anyone who drives under the influence of drugs or alcohol. 

Now, because more than 75% of our medical costs are from the second category (both in terms of hospital treatments, clinic visits, and usurious drug expenses), the numbers get interesting.

“Bad Luck” or “victim” insurance would be so cheap the government could easily afford to give it away as a universal right for all.  Probably would cost a lot less than it currently spends on giving free operations for the uninsured who could not afford to prevent their illness to avoid the operation in the first place.  But like flood insurance in a known flood area, exclusions to this basic plan would be clearly stated. 

“Bad Choice”  or “high risk” insurance would be private, and these insurance companies already have expertise in scaling the risks.  In other words, smokers pay more for home fire insurance, and drivers with a DUI record or a history of speeding fines will pay more car insurance.  Discounts could even be offered for memberships in an exercise facility, or for being in a healthy weight range.  So if you have alcohol on your breath, or cocaine in your blood stream, you will still be fully covered for all medical consequenses.  But note that these premiums are private, and could be very expensive.  If you agree to go to rehab and are certified clean by your doctor, your rates drop!  If you go on a supervised fitness and diet program, and are certified back to low risk by your doctor, you can go back to the regular universal insurance.

So FINALLY we have a reason to behave!  The cost of bad choices should not be subsidized by those who make good ones.  If you are an innocent victim of your disease, say high blood pressure, your universal coverage takes care of you.  If you actively caused your own blood pressure to rise, say by sloth and gluttony, you need to have the private high-risk plan.  

 If we can all accept that the drunk driver with a litany of speeding offenses must pay a lot more car insurance than the safe driver, then why not apply the same point to our medical insurance.  Otherwise, the dangerous driver would never feel the financial consequenses, as they would be paid for by the good drivers.  Nice way to generate anarchy on the roads, and a ”car insurance crisis”.  But note that this is not inhumane; the bad driver, once certified as reformed (and not getting more violation points on their license), can eventually resume lower rates. 

So instead of Nationalizing health care, let’s try to Rationalize health care, the way we do for automobile insurance.  Nobody should lose their home because they have a child with a rare disease, and the morbidly obese should not expect free knee repacements or liposuction.   Healthy twenty year olds should not have to pay $1,000 monthly premiums to cover the costs of scraping Velveeta Cheese out of the coronary arteries of 40 year old sluggards. 

 Let us have the basics included for all, then allow the risk takers to select their own private insurance carriers and pay according to their chosen risks.  With any luck, they might think twice about their self-induced disaster path, once they see the financial costs!

Dr. Peter G. Hanson is an MD-acupuncturist in Denver, specializing in managing pain, stress, and injuries.  He practiced emergency and family medicine in Canada before moving to the US in 1992.  He has written the international bestseller “The Joy of Stress”, (translated into over 15 languages), and co-developed the FaceMaster with Suzanne Sommers.  Visit www.peterhansonmd.com, and www.facemaster.com.