I originally imagined the Medical Savings and Loan as a product line offered by an insurance company. This plan was for companies that wanted to give their employees greater direct control of their health care.
I had temporary access to state actuarial data. I explored this data asking the question: which group would fare the best with a transition from insurance to the Medical Savings and Loan. To my surprise, it was the working poor.
What I discovered was that the working poor were paid health premiums but were being short changed on the care received. After paying a health premium, the working poor had no money for paying the deductible. Even worse, when trouble happened, they couldn't pay the next year's premium.
The working poor pay all sorts of money into insurance and get thrown onto the welfare roles when they need care.
I concluded that the working poor would be better off skipping insurance and putting their health care dollars into a structured savings plan.
Realizing that the working poor were drastically underserved by insurance, I developed a second version of the Medical Savings and Loan for the working poor.
In this plan, a charitable foundation would offer interest free health loans to people with unmet needs.
If a person accepted the loan, the foundation would assign a case worker and slam him into a structured savings program.
The charity isn't expecting to get the money back. They would benefit by getting some money back. Let's say a charity lent out a million dollar and got half of what they paid back for new loans. If they repeated this process, they would be able to buy $2 million in care.
The Medical Savings and Loan as a charity has the effect of helping the working poor optimize their personal resources and it helps the charity optimize the impact of its giving.
The program would also decrease the number of working poor who fall into the welfare roles.
There could be some immediate positive impact in developing a social policy around the Medical Savings and Loan.
For example, The Medical Savings and Loan could reduce the insanity of people showing up at expensive emergency rooms for primary care. If the working poor had the choice of getting slammed with an expensive loan at the emergency room or getting slammed with a smaller loan at a charitable clinic, most would head toward the lower cost clinic.
The Medical Savings and Loan as a charity is different from the Medical Savings and Loan as an insurance line.
Through the years, I've developed different configurations of the same concept to address different health care challenges.
When people ask me for specifics of the Medical Savings and Loan, I actually have to respond that I've large number of different configurations of the program to address different needs.
The idea that the Medical Savings and Loan can be configured as a charitable organization is very much in my mind.
I've de-emphasized it because I want to concentrate on the concept of self-funded care.
I contend that our health care debate is backwards because we start from the wrong place. The health care debate should start with a discussion of the needs of people who are able to self-fund their care, then it should move into a discussion of what to do with the people who can't.
When we start the debate at the end and work back to the beginning, we end up with a backward health care system.
If I can ever find a place where I can give my presentation, I will talk about creating a system to help people self finance their care for an hour. Then I will talk about how the program helps people who are not able to self finance their care.