PBR, NIH, AND...

THE ABCs OF HMOs

By William Westmiller
10/28/98

Not long ago, insurance was considered a pact with the devil. If nature's god brings you suffering, it's a sacrilege to profit from your wager. The efforts of politicians to conquer the whims of fate are certain to suffer the slings and arrows of misfortune. The recent Patient's Bill of Rights and HMO reform efforts are doomed to failure, but only if they are successful. The kind of logic that only angels can comprehend? Not at all.

Medical insurance is a wager. You bet that you'll have really bad luck and get sick. If you have good luck and remain healthy, all those premiums are wasted money. You make the investment in insurance because you know that insurance actuaries have calculated the odds, added a token for their efforts, and offered you a little peace of mind until disaster strikes. That's the game. The rules can't be changed, even if you are a highly respected and astute politician.

A few decades ago, government decided to grant a little tax bonus for individuals who bought their medical insurance through their employers. Businesses were allowed to deduct the cost of all those individual policies from their corporate profits. A reasonable proposition, because it was just another labor expense. But, for individuals, costs became invisible and expenses were the employer's obligation. Health services became a free commodity and everyone wanted a specialist to cure every minor ache and pain. Demands on the medical profession grew, expenses grew, and that little tax bonus became a major deficit for employers. The roulette table of the actuaries had been tilted.

The only way for employers to limit their losses was to lock up the hypochondriacs. Restricting access to the most expensive treatments for minor medical discomforts was the only way insurance companies could reduce the employer's expenses. The gatekeeper was born. The Health Maintenance Organization (HMO) became the guardian of medical norms, calculating therange of valid symptoms and appropriate treatments for every medical condition. With the aid of government health institutes, doctors and patients were eliminated from the decision making process. After all, they were only incidental players in the game. Patients with sinus congestion would no longer be free to consult an allergy specialist for the latest blood tests and CAT scans to solve the conundrum of their affliction. The HMOs would give them the option of buying nasal spray off the pharmacy shelf or taking a warm shot of chicken soup. Solved the problem. Tipped the table. Now, both patients and doctors bridled at the restraints.

Politicians don't like unhappy voters. Government promises something for nothing and the saviours of modern medicine couldn't fathom the consequences of their generous efforts to fix the tables of chance and fate. Voters should get everything they want, the way the want it, and damn the actuaries. Toss the rules, tip the tables, trounce that devil hiding under reams of facts and figures. Fix the game.

Fortunately, the fates will frown on mere mortals trying to beat the odds, even if the mortals agree universally on what reality ought to be. Give patients absolute freedom in selecting doctors and demand will increase and costs will rise. Give doctors complete discretion on treatment and the most expensive options will be found and costs will rise. Granting all the wonderful rights that governments may and the damage will exceed the benefits on every count. Better to wish and hope and pray to the angels of good health than to depend on coercive government programs to tip the scales of medical justice in everyone's favor. The odds are what they are, even when they change. Reality doesn't care what rules and regulations are imposed on medical practice. It only responds when individuals accept the odds and take responsibility for their own choices. Like it or not, everyone has to play reality's game.

Insurance always was and always will be a calculated bet you make with your broker. Whether your broker is an insurance agent, a gatekeeper corporation or government official. But health is not a wager. Good health is no accident. There are no actuaries in the world who can calculate how well you treat your own body and no government bureaucrat who can force you to make the best choices. The scourge of the greater powers is that you are an individual biological unit and the decisions you make about your health are beyond anyone else's calculation or control. You are your own best HMO. But, the cost is that you must always pay fate it's due. And the devil is in the details. It's a bet you should make on your own best judgement, because theconsequences are all yours. The next time government offers to tilt the scales for you, invite them to just stop loading the dice.

©1998, William Westmiller
California Coordinator of the Republican Liberty Caucus
Past Candidate for the Republican Nomination for (24CD) Congress
Former National Secretary, California Chairman, Libertarian Party
hmo_pbr.c11 ~800 Words