Julie Mack: Imagining a US health

KALAMAZOO, MI -- Dr. Michael Park, a specialist in allergies who has a practice in Portage, says the secret to reforming U.S. health care is cutting insurance companies out of the equation.

Park, 46, outlined his vision in response to a column I wrote last week.

'You need to look at the big picture,' he wrote in an email. 'We're talking a totally different paradigm. A totally different system.'

In his vision, the United States would reform its health-care system by enacting dramatic tort reform; making people pay more out-of-pocket if they wanted access to the latest and most expensive technology, and rethinking our approach to end-of-life care.

But the key to his vision is deep-sixing insurance.

'Quite frankly, the only way I can think of to restore true market forces in health-care costs is to eliminate health insurance as we know it,' he writes.

'Then the price would more closely reflect supply and demand. .... If all health insurance were eliminated, I submit that all healthcare prices would rapidly plummet by 25-50% With the middle man out and physicians and patients dealing with each other directly, prices would fall.'

His idea: Instead of subsidizing insurance premiums, employers would put that money into a pre-tax medical fund that people would use to pay their medical bills.

'Obviously the very poor would still require the charity of others for the more expensive aspects of healthcare,' he added. ' That has always been the case and that always will be the case.'

'It could work,' he wrote about his no-insurance idea. 'It would reduce the cost of healthcare to the lowest it could possibly be.'

He added: 'Of course, I realize this will NEVER happen. It'€™s too radical a change. Most people wouldn't be able to wrap their minds around it and there would be too much fear.'

As a more palatable alternative to his idea, Park proposed a system where Americans would have catastrophic insurance to protect against bankruptcy, but essentially keep the role of insurance at an absolute minimum to let the free enterprise system work.

Park puts his finger on a central issue in U.S. health-care costs: It's estimated that administration -- including processing claims, advertising and the insurance companies' profits -- account for about 30 percent of health-care expenditures.

He also highlights the insanity of the current health-care pricing system, in which there is no one set cost for a product or service -- the bill varies hugely, depending on the type of insurance or lack thereof, accompanied by a minimum of transparency.

Park readily acknowledges the biggest downside to his vision: It would face fierce opposition from many, including insurance companies as well as health-care providers who would feel the negative impact if U.S. health-care spending plummets.

And while Park says his system would benefit consumers, that's not so clear.

It's a fair bet that if Americans paid for most health-care bills without insurance, spending would drop and probably substantially.

But a big reason, I think, is that many people would simply limit their use of the health-care system. Do we really want a country where children go without vaccinations? Where people ignore chest pains?

Even if the average cost of delivering a baby was cut in half to $15,000, how many 20-somethings could afford that? What happens if the baby is premature or critically ill and racks up six-figure medical bills? What are the chances that a health-savings account would have enough to cover that?

We've already seen that world through the eyes of the un- and underinsured, and it's not pretty.

Still, Park's ideas are worth throwing on the table for discussion. Moreover, he's not the only one thinking along these lines.

In 2012, Dr. George Lundberg, former editor of the Journal of the American Medical Association, wrote an op-ed piece titled 'An America Without Health Insurance Companies.'

'I would expect most ambulatory care to be paid out of pocket up to a means-based annual deductible,' he wrote. ' And I would insist on means-based ' catastrophic coverage' for ALL Americans.

'I would expect the government to pay for preventive services for all that had been proven to be safe and effective, considering them to be public health.'

Essentially, Lundberg is proposing a variation on Medicare -- i.e., single-payer.

That's definitely not the direction Park wants to go -- his practice doesn't accept Medicare or Medicaid patients -- but it's also hard to imagine health care without a safety net for individuals.

If not insurance, if not the government, then what?

Julie Mack covers K-12 education and writes a column for Kalamazoo Gazette. Email her at jmack1@mlive.com, call her at 269-350-0277 or follow her on Twitter at kzjuliemack.