Buy direct! Cut out the middleman!

You hear it from furniture manufacturers, local farmers, and on-line insurance companies. It's more efficient, with less frictional costs, and (at least in theory) is lower priced that way.

But that option is not on the table when it comes to health care reform. NPR has been following the debate and ran this little piece on it. I couldn't agree more.

Trying to preserve the current multi-party system of buyers, providers and consumers is what will keep reform from working. It's what has made the system antagonistic and inefficient in the first place. Medical providers fight with insurance companies over costs and coverage. Doctors point the finger at lawyers for raising costs due to over malpractice lawsuits. Insurance companies accuse both doctors and lawyers of raising costs. Employers blame insurers and doctors for making health insurance too expensive.

And the consumer... who essentially makes NO buying decision and has NO leverage... is on the short end of the whole thing. And they are the ones who are supposed to be served.

I work for an insurance company. I see all the gamesmanship seminars, accusations, lawsuits and vitriol being spilled on this issue, and it's all based on chasing money. Whether you're a lawyer, a doctor or an insurance exec, it's all about maximizing earnings. For my two cents, the profit motive needs to come out of the health care system altogether, and single-payer is the way to do it.

Think of how we do education in this country. We have a fairly large public system, along with some private schools. In the public system, all educational employees work for the government. The general rules come from the Federal Government, the funding comes from the State and Municipality, and diection comes from oversight by a local elected school board. Private schools have some rules to abide by, yes, but they have a lot more freedom of movement. People can choose to go there if they can afford it on top of their normal tax burden for the public schools.

You could do the same with public health care. All medical providers become employees of the government, not of hospitals or clinics. Hospitals and clinics are organized by "medical districts", with a local elected public health board giving oversight. Provider salaries are set on a scale through collective bargaining. The government certifies who can practice what. Since income is from taxes, everything is non-profit. And if people can afford to go to "private sector" doctors... they can. There will still be some oversight, but a lot more freedom (and risk).

If it works okay in education, why not in health care? And that's only one possible model.

You could talk about other models, like the one we use for public utilities (power companies, water districts, etc.) Some blend of government oversight and public trading of stock, with an elected state utility board.

We don't have to stick to the contentious, inefficient, profit-hungry system we use now. Let's get creative, Congress!