A post by Andrew Barna

In Back to the Future, Dr. Emmit Brown's great idea came to him when he hit his head on a toilet. It wasn't a great medical discovery, but the flux capacitor did "make time travel possible". Well my idea came in the middle of the night. It was the relationship between patient, provider, and payer that should exist. Now I have not discussed healthcare financing or "fixing healthcare" in a while, but it is an issue we should all participate in. So amidst all the talk about consumer directed healthcare (CDH), here are my 2 cents.

So here is the idea. The green lines show the flow of money and the red lines show value delivered. Notice the direction of the green lines. In exchange for healthcare services (red line from provider to patient), the patient, as the primary beneficiary of the services, is responsible for paying the provider. All the other green lines go to the patient. Why? Because the individual provides value to the employer and to society by being healthy; therefore, employers and society (i.e. - the government) should help people pay for their medical care. This is not to say that people should be put into debt because they have to have surgery or contract a terminal disease. Perhaps the government could subsidize personal medical debt based on income, diagnosis, or some medical debt/earnings ratio. The reality is that the patient is the true consumer of medical services and it is most natural to place the financial responsibility on the patient's shoulders.

The idea certainly needs alot more fleshing out and the healthcare marketplace is a bit more complex, but in a number of ways, we have already started moving in this direction. HSAs and CDH already have more of the healthcare expenditures flowing through the patient and tax incentives are a first step in the government's role of subsidizing healthcare for the individual. Imagine funneling more of the governments enormous healthcare expenditures through individuals. Rather than paying providers directly, the government would subsidize the patient's healthcare choices. If the patient (working with his or her provider) decide that the patient needs one more MRI, then the patient would take on that financial responsibility and the government would throw in its "two cents" to help the patient cover the cost. This is on top of the "two cents" that the employer is pitching in to ensure a healthy workforce.

In the end, it is a more equal distribution of the financial responsibility for healthcare (yes, that means individuals would pay more - right now most of us pay a small fraction out of pocket), while putting the patient, the true purchaser and beneficiary, at the center.