Sane health care after Obamacare crumbles

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The disastrous roll-out of Obamacare has more than vindicated all of its critics, even though the roll-out has barely started and employers' mandates haven't yet kicked in.

Next year, when they do, even more people will lose their health insurance. But Obamacare critics should not wait until that regrettable reality arrives to propose something different and better. They have the opportunity -- and obligation -- to do so now.

A simple repeal will not suffice. No free-market conservative suggests that we return to the status quo ante, because the nation's health insurance system, pre-Obamacare, was not truly a free market.

Instead, it was, like the new program, an expensive, overregulated, inequitable mess designed to do more for insurance companies than for the insured. President Obama and his "progressive" allies were not wrong in their criticisms of our old health care system; they were just disastrously -- and foreseeably -- wrong in their prescription for its overhaul.

The first step in shaping a health care system that will actually work is to acknowledge a common-sense consumer truth: The more people required to create and deliver any item or service, the more it will cost.

So we should cut out the middleman whenever possible.

When is this possible in health care? When you're paying for routine care. This is obvious when you think about another kind of insurance that many people carry: car insurance. The vast majority of auto policies do not cover oil changes, new tires and yearly inspections. (Until hearing a recent radio ad, I would not have believed such insurance was even available. I'm flabbergasted anyone would buy it.)

So why shouldn't we health care consumers also cover our "yearly inspections" out of pocket? (I'm trying hard to think of an anatomical equivalent for new wiper blades and oil changes. ... I'll leave that up to you.)

I know firsthand this principle applies to health care because I have an uninsured son.

He has aged out of our plan and does not have coverage through an employer; so when he needs a doctor's or dentist's services, he asks what an appointment or procedure will cost if he pays right then, out of pocket, with no insurance paperwork to handle. His cost is routinely half what an insured patient pays.

The law should allow us to buy only the health care coverage we need.

Under Obamacare, everyone is required to purchase insurance that covers a comprehensive list of possible health expenditures. "Inadequate" policies are being canceled.

But why should a 55-year-old woman who's childless be required to have coverage for pregnancy, pediatric care and prostate exams? Obamacare strips that woman of her current policy and forces her to buy a more expensive one.

We should make health insurance independent of our jobs and job changes.

Health insurance came about in the post-World War II boom when wage and price controls prohibited employers from luring new employees with higher salaries. So employers hid higher salaries as "health insurance" and to this day, employer-provided insurance is a tax-free benefit that is actually salary in disguise.

Instead of this highly unequal situation, each citizen should receive a tax credit with which to purchase the policy of his or her choice, independent of employment. Each adult citizen should be able to contribute, tax-free, to a portable health savings account (HSA) to cover both routine and nonroutine expenses.

The federal government should allow insurance companies to offer their products across state lines and should allow the 50 states to decide the rest.

One size does not fit all. What's needed in Massachusetts may not work in Montana, but in general a combination of HSAs for routine costs and catastrophic insurance (for health crises) will carry most families through life.

If a state chooses not to require catastrophic coverage, and a citizen eventually faces a health crisis, state law can empower and regulate a provider's right to compensation.

And since an enormous amount of our health care dollars are spent on invasive, end-of-life procedures, insurance companies and governments alike should offer incentives to individuals and families who work out and sign advance directives.

The biggest opponents of these free-market principles will be fans of big government and big insurance companies.

By early 2014, consumers should have had enough of policy loss, sticker shock and reduced work hours caused by Obamacare to rise up and drown out the leftists' and the insurance lobbyists' voices with a call for free markets and common sense.

Ruth Ann Dailey:

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