Health care Reform and 3rd Party Payer System

A third party payer system is when the consumer is actually not the person directly paying for what they are consuming. The system works like this: You the consumer give your money monthly to someone else (like an insurance company) then you go shopping for something (like health care). You and the vendor come to an agreement on what you are going to get and the third party - the insurance company - actually pays the expense.

Imagine that you walk into a hardware store to buy a hammer. First thing you do is go see your home maintenance manager. He asks you why you are there. You explain to him that you need a hammer to drive some nails into a board, showing him pictures of the board to prove you are in need. He says fine and gives you a referral to see the hammer specialist.

You walk over to the hammer specialist with your referral slip. He shows you a selection of two hammers with wooden handles. You have a problem with that because wooden handles destroy trees which harms the environment and you want a hammer with a handle made from a new environmentally friendly material. The hammer specialist explains to you that your hardware insurance only covers the wooden hammer because there is a state law that requires all insurance companies to cover wooden handled hammers but not others.

In the end since the insurance company will cover the hammer with the wooden handle you take it and leave the store happy. You don't have to pay anything. It wasn't exactly what you wanted but the insurance covered it and you had no out of pocket expense. You also feel a small sense of satisfaction that the hardware insurance you have been required to carry by law finally got used.

You will never know actually how much was charged to the insurance for that hammer unless you put some effort into finding out. As a matter of fact you aren't even really sure how much you pay for hardware insurance monthly because it is a combination of payroll deduction subsidized by money you pay out in income tax and a series of other taxes you don't realize you are paying.

Through some inspection you discover that the hardware vendor charged $200 for the hammer and the insurance paid $75 for a hammer that normally would cost $10. The real cost to you was about $150 but because the costs are hidden from you through taxes you don't see this.

Another thing you are unaware of is that because there are a few centralized third party payers in the hardware world it is easier to regulate the market through legislation. Large companies in the market are able to lobby legislatures and other influential politicians to get them to make it law that their products have to be covered by the insurance companies. This is a great way for them to control the consumer who is being forced to pay into the insurance system.

The above ridiculous example is how health care works under the current third party payer system with the exception that, at least for now, we are not required to carry health insurance by law. But state governments and the federal government do use their authority as law makers to require insurance cover certain health care products and services. The consumer routinely does not pay directly for service or even know really how much it costs.

I guess it could be a solution to have the government further regulate health care. However what we really want is a system that gives the best health care possible in the most fair and efficient system. A suggestion is actually to create more of a free market system with the elimination of the third party paying system. I am proposing some regulation which would be to outlaw third party paying systems due to their lack of transparency to the consumer and great propensity for limiting competition. Instead one takes out fixed amounts of insurance to secure themselves in the case of illness. You can insure yourself for $20K worth of benefits if you contract cancer. If you get cancer the insurance company pays you $20k and it is up to you to spend it as you see fit. Now hospitals and care givers and others in the health care industry have to compete for your business.

One thing that is not given enough attention in the health care debate is why are costs so high. In any other industry competition results in better products, better service and lower costs. This is not happening with health care because the health care market is not a free market where suppliers and vendors need to respond to consumers. President Obama made an excellent point that the incentives inherent in our current system are mixed up. The solution is to put the consumer back into control by removing the practice of third party paying.