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07/21/17

Draining the Miscellaneous Bucket

We are in a series outlining the big ideas that would serve as the foundation for Tim’s proposed healthcare reform plan.  Click here to find the prior posts.

Money is, perhaps, the world’s most sensitive subject.  Money issues are a leading cause of divorce.  Jesus talked about money more than he talked about heaven.  Money makes people weird.  OK, weirder.

No one really wants to be completely forthcoming on their spending.  Maybe it is shoes and hair products, or the true cost of golf, but most of us have a thing or two that we want to keep fuzzy.  We have little ‘miscellaneous’ buckets, money stashed away that can be spent without our spouse or the boss or finance cops knowing too much.

Experts say getting all of this out in the open is the key to making changes.  They advocate getting specific with every dollar.  That is generally a good idea (except for what you spend on your dog…nothing good comes from being explicit there). 

The principle is right on if we are to solve our healthcare issue.  As I said last time, I’d advocate a tax, and it will be material, to cover the cost for people with multiple chronic conditions who simply can’t afford to pay for their own care.

I am not an expert in tax policy or mechanics.  Instead of pursuing that field, I chose to have a life.  So, get some of these types in a room and figure out if we should tax income or payroll or the health premiums of everyone else.  I am sure one approach makes more sense.

However, I might suggest some combination of state and federal taxes because some states have more sick people than others, but I like at least some of it coming from the states themselves because of the discipline it imposes when you can’t print money.

Yes, yes, yes, there will be abuses.  Like there aren’t now?  Red herring argument.

Yes, we need to figure out how to motivate these particular people to make decisions to help improve their care and lower their cost, but they already have and live with these diseases, so stop acting like getting them to wear a FitBit will solve this problem.  This will seem outlandish, but I’d give financial upside to both providers and patients if they can, together, lower the cost of care.  Why wouldn’t we pay a hypertension patient to NOT eat a cheeseburger?  You want to argue the ‘rightness’ of that, or do you, the one paying this tax, want to figure out how to lower the cost?

The guard rails of transparency; big ‘don’t you dare’ penalties for abusers; and control as local as possible are fine, but not at the expense of restricting the freedom caregivers on the front lines to innovate new ways to solve this problem.

So yes, tax me to pay for this.  We’ll see next week how we should still come out ahead.

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ALN

Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

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