When I was an intern at Johns Hopkins Hospital in the 1970s, I was very impressed by the caliber of patients on the wards. There would be presidents and CEOs of large corporations, as well as queens and crown princes of various countries, many of whom were dying of horrible diseases and all of whom would be quite willing to give all their wealth and titles for a clean bill of health.
It was easy to understand that there is not much in life that is worthwhile without your health. It is by far our most important possession, which we should jealously protect. For this reason, I heartily agree that we as a nation need to focus significant emphasis and resources on providing good health care for all of our citizens. My question is this: Can we provide this without turning over control of our most important possession to the government?
Some will say we have already relinquished it, so why talk about it any further? Others say only the poor are affected by Obamacare, and everything remains the same for all the others. Of course, this is not true, since the many regulations associated with the health care law affect everyone. Also, the economic impact does not occur in isolation.
Rather than complain about Obamacare, it might be useful to begin to discuss some enhancements or future alterations that can make it work effectively or provide an alternative if it fails. The first question is, what do you need for good health care in America?
You need a patient, a health care provider and a mechanism of payment. Along came a middleman — namely, the government and the insurance companies — to facilitate the relationship. Now the middleman has become the primary entity, with the health care provider and the patient at its beck and call. The whole enterprise has been turned upside down.
In order to right the ship, we need to return the responsibility for good health care to the patient and the health care provider. One of the best ways to do this is through health savings accounts, which patients can control. Even if the federal government provided such an account for every American citizen that was increased by $2,000 each year, it would cost less than $700 billion a year and everyone would be covered.
Keep in mind the fact that more than 150 million Americans are employed and their $2,000 per year in most cases would be happily supplied by the employer if that was their only health care obligation. This would make employers much more likely to want to expand their businesses and hire more people, and it would decrease the government’s entitlement obligations by hundreds of billions of dollars per year.
At least a quarter of the $2,000 per year would be devoted to bridge insurance or catastrophic insurance, and all citizens would have the right to contribute to their health savings accounts from other sources without limit. It would also be possible for people to transfer funds between accounts within a family.
For example, if a husband needed care and was a thousand dollars short, his wife, son, daughter and father could make contributions from their accounts to cover the expense. This would essentially turn each family into its own private insurance company with no middleman.
It should also be possible for everyone to donate up to 5 percent of the value of their health savings accounts to anyone of their choosing in any given year. For example, if there was someone in their church or an associate at work in need and for some reason didn’t have adequate resources in his account, his fellow members and associates could band together and donate a portion of their accounts to cover the expense.
This would create a strong sense of community, which is a very good thing. Since one could pass his savings on to a family member or anyone of his choosing at the time of death, there would be no incentive to spend everything in the account before dying.
Over the course of a lifetime, it is likely that most people would have accumulated quite a significant amount in their health savings accounts, and it should be possible after reaching a certain dollar amount for people to withdraw a percentage of their savings for their personal use in any way they deem fit. For some elderly people, this could serve as a very nice retirement supplement.
As time passed, individuals and families would accumulate extremely large amounts of money, and the government obligation would become smaller. Instead of the government becoming a bigger part of each person’s life, it would diminish, reducing the need for ever-increasing revenue streams.
This is just the basic framework of an alternative system to Obamacare that involves thinking outside of the box. With additions from positive and creative individuals, it could provide universal coverage that is simple to understand and truly affordable.
Ben S. Carson is professor emeritus of neurosurgery at Johns Hopkins University.