本文出自《财富》杂志，文章主要以肖恩·马萨基·弗林在书籍《The Cure That Works 》中提出的内容，总结了美国医疗制度现存的问题。
What about single-payer systems such as those in Canada, the U.K., France and elsewhere?
Flynn bluntly shows how they control expenses: by rationing. You wait and wait to visit a specialist and,depending on your age and condition, you may not be treated at all.
Could a free-market health-care approach work in the U.S.? Of course.
Two examples where this is already being used are elective cosmetic surgeries and LASIK eye surgeries, which aren't covered by insurance.Nonetheless, demand for both has zoomed. Results? Outcomes have improved, and prices, adjusted for inflation,have dropped by almost 50% for LASIK operations and 25% for cosmetic procedures over the past 20 years.
The state of Indiana provides another example.
Back in 2007 it offered state employees the option of taking a high-deductible policy with a health savings account (HSA).
The deductible was $2,750, with Indiana putting that amount each year into the employee's HSA,which became the employee's personal property. The worker would pay 20% of costs above that, up to $8,000; anything above that was covered 100%.
The total out-of-pocket expense in a year was thus capped at a bit more than $1,000.
Employees in this plan reduced their spending 35%, because they suddenly had an incentive to get value for their health-care dollars,such as choosing generic drugs over the more expensive brand names and visiting acute-care clinics instead of rushing to a more costly hospital emergency room.
Flynn's irrefutable bottom line: We should vigorously pursue high-deductible health insurance policies with HSAs that would cover the deductible and be paid for by the employer, combined with posted prices for everything offered by providers.
Conditions may be ripe for such a profound change. Employers are already going for high-deductible policies,but many are not attaching them to robust HSAs. In addition, HSAs are hobbled by unnecessary restrictions,such as a ban on using them for over-the-counter medicines.
As a start, Washington should require insurers to offer such policies in addition to their traditional ones and should remove those HSA constraints.
By the way, Indiana is also successfully pioneering a Singapore-like approach for its Medicaid program.