The Director of Health Policy Studies at the Cato Institute talks about the importance of who controls the money in the American healthcare system.
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Why is Consumer-driven-healthcare so important? I think what's different about this is consumer-directed healthcare is actually changing who controls the money and that's the whole ball game right there. And for the past 60 years, in the private sector, employers have been controlling the money that purchases the consumers' health insurance. And then starting 40 years ago, the government's been in control of the money that purchases healthcare for the poor or for the elderly. And every change that we have made up until the consumer-directed healthcare movement has been geared toward taking money out of the hands of consumers and giving that money to someone else to control. But what we are trying to do with health saving accounts, flexible spending accounts, health reimbursement arrangements is actually return control, return ownership over that money to the consumer, because then not only is the consumer going to make smarter decisions but the system is going to reorient itself to serve their needs for information and higher quality care and more efficient care. So I think it's really a revolution in the sense that it's returning control over that money to the people who earned it. What needs to happen to improve United States' healthcare system? I think the most important thing that has to happen to improve America's healthcare system is we have to return control over the money to the people who earned it. So all of that - the economists have us said that $12000 an employer spend on family coverage isn't really a gift from the employer. Their workers earn that money. But for some reason the employer gets to control it. Actually we know the reason. It's the provision of the tax code that give preferential treatment to employer sponsored insurance. What we need to do is give workers control over that money. Let them own that money and make the health insurance decision themselves, because they are going to make better decisions for themselves, they are going to get more information about how to make those good decisions. We are going to have a much more efficient and higher quality sector than we have got right now. Why are you here? Really what I have been hoping to take away from the congress is, information and ideas on what's happening and what could be happening in consumer directed healthcare, and I think the panel that I was on was very good, and the panel that came before mine also was also informative. We are hearing from the folks at Kaizer that actually they have been trying to and have been succeeding at providing a lot of things that consumer directed healthcare isn't providing right now, people health saving accounts aren't getting like the ability to email your doctor, and get him on the phone. They are already providing that in Kaizer, are the things that we can learn from Kaiser and can we bring them into the consumer directed healthcare movement? I think we can, and I think the key is to give the worker that money that the employer is controlling and let them choose, whether it's the deductible fee for service plan or a closed panel HMO that gives this sort of information and convenience to the consumers. Is there danger in putting more control in the hands of the patients? There is a lot of concern if the consumer controls the money and has the option of spending their healthcare dollars on something other than healthcare that they will make bad decisions and they will harm their health. But fortunately we don't have to guess it whether that's going to happen or not. We have got evidence to show that, no it doesn't. When the RAND Health Insurance Experiment about 30 years ago put people in different health plans one of which gave them access to free health care and another one gave them a health savings account like plan, the people who had free healthcare used 43% more care but they weren't any healthier, they didn't end up any healthier than the people who managed those healthcare dollars themselves.