On Insurance Workers

This is an interesting Tweet from Dr Shane:

"for every two doctors in the U.S., there is now one health-insurance employee—more than 470,000 in total" David Goldhill #DPCrising

Dr. Shane and David Goldhill blog about the rising costs of health care regulations.

I want to approach the number of insurance positions from a different perspective.

I once worked in insurance. My experience was that insurance employees are wonderful people who really want to help people with health care.

I see 470,000 wonderful people, most of whom are trying to make a positive difference.

The reason I left the insurance world was because I realized that the nature of insurance prevented me from making the positive difference that I imagined insurance offered.

The problem is not with the people, but with the configuration of insurance.

In the current system, our health care dollars sit in enormous pools. The money in this system flows from powerful insurance pools to industrial style hospitals.

A bureaucracy configures itself to the flow of money.

The careers of these 470,000 people end up aligning with the needs of the the insurance pool and not the the needs of the people.

The reform I propose is called: "The Medical Savings and Loan."

This reform starts by giving policyholders a medical savings account. All medical transactions flow through the account.

We replace the insurance pool with a thing called a loan reserve. Policyholders buy a share in a loan reserve. This reserve has about the same amount of money in it as the insurance pool.

When a person needs care, the money comes from their savings account. If there is not enough money, they can get an interest free loan from the pool. People who make enough to repay their loans are expected to repay the loans. Those who cannot receive grants.

The Medical Savings and Loan changes the flow of the money.

As bureaucracies shape to the flow of the money, the flavor of these 470,000 positions will change. The worker's efforts will start aligning to the needs of the people.

To emphasize this re-alignment, I created a new title: "The Health Care Advocate."

The driving mantra of the Medical Savings and Loan is: Those who can self fund their care should. The system redistributes money for those who cannot.

The Health Care Advocates help policyholders set up their savings plan. When people need care, the advocates help people find doctors and help in the negotiation of prices. When needed the advocates will apply for loans and grants.

Because the money flows from personal accounts to health providers, the work of these professional changes.

If we simply changed the structure of our health care system from pools to personal accounts, we could force a complete re-alignment of the insurance industry and all the positions in it.

Our problem isn't that people in insurance are bad and evil. The problem is the flow of the money.

Follow the money. The way the money flows creates an inefficient system.

If the money flowed from personal accounts to providers; then we would see these jobs align with the needs of the people.

Insurance companies have the job of protecting the pool. Health Care Advocates have the job of helping people maximize the return from their health care dollars. These advocates would be like personal financial assistants. Changing the flow of mone changes all the positions in health care and this improves care.

I think it is wonderful that 470,000 have jobs in insurance. I have no desire to make these wonderful jobs go away. I want to see their jobs aligned to the needs of the people and not the needs of an insurance company.

A Doctor on America's News Room

I walked by a TV set and saw some talking heads on Fox actually talking about health care reform. The people may have been Bret Baier and Dr. Marc Seigel.

I am ecstatic. Most conservatives I know are intent on preserving Obamacare (under a different name) and refuse absolutely to discuss free market health care reform.

Sadly, what the doctor said was idiotic.

The doctor said the two keys for health care reform were tax deductions and the ability to buy insurance across states lines.

I wanted to scream. Tax deductions only help those who have active income streams. The people who are most in need of help have no income.

Buying insurance across states lines is going to make health care a nightmare.

The biggest problem is that interstate insurance companies do not have contracts with local health care providers.

If your employer decides to save money by buying insurance across state lines; you are likely to find that few local health care providers are willing to take you case because they do not have a contract with your insurance company.

This next paragraph might sound strange to readers, but it is the basis of insurance.

Group insurance works as follows. A group of people place their health care resources into a pool. When individuals need care, they and their doctor file an insurance claim against the pool.

The insurance claim is a lawsuit which is overseen by the court system. Currently the jurisdiction takes place at a state level.

I need to repeat this: An insurance claim is a lawsuit. You put your money in a pool and you must sue the pool to get the money back out to pay for care.

The reason that medical billing is so bizarre is because it is designed for processing through the legal system.

The current system is nuts.

Insurance companies and doctors try to streamline the claims by creating local buyers network. In these networks, insurance companies negotiate the prices of goods and services with local doctors.

These insurance networks are, theoretically, the cost saving mechanisms of insurance.

Insurance companies often have large directories showing which doctors are "in network." These doctors have negotiated with the insurer to provide care at a set price.

When your employer decides to save some money by buying insurance across state lines, you will find that there are few "in network" doctors.

Having few in network doctors means you will not receive the care you desire.

If your employer buys insurance across state lines, you might find that many doctors refuse to accept your insurance because they do not want to take on the hassle of filing an insurance claim in a different state.

Anyway, I was ecstatic to see people on TV discussing health care reform.

Yes, I was disastisfied with the discussion, but people have to go through multiple discussions to find a good solution.

A discussion about free market health care reform must go deeper than talk about tax deductions and state lines. We need to discuss the foundations of health care. If anyone wants to engage in a substantive discussion about health care reform, they could contact me. I have research on hand that would serve as a basis for an illuminating discussion.

Nationalized Health Care Regulation

Prior to ObamaCare, Insurance was regulated at the state level.

Sadly, state regulators tended to become the lapdogs of local insurance companies. State level regulations tended to align with the desires of insurance executives and not with the needs of the people.

I want to point out that this problem arises from the nature of health insurance. Putting all of our health care dollars in huge insurance pools creates powerful entities that can bully the state.


The US founders did not want an overbearing Federal government. This is why they created a Constitutionally limited Federal Government.

The founders wanted a system where the individual states could experiment with different ideas about local governance.

ObamaCare wrested control from the states and gave it to the national government.

BTW, the process of wresting control of an industry and giving it to the national government is called: "nationalization."

ObamaCare nationalized insurance regulation.

Repealing ObamaCare means denationalizing insurance regulation and returning it to state control.

Donald Trump's going on air and saying that he seeks to keep provisions of ObamaCare means that we will keep regulation of insurance at the national level. It also means that we lose the ability for the states to become laboratories of local regulation.

I did not jump on the Trump bandwagon during the campaign because I did not hear the campaign give specifics on health care reform.

The only specific Donald Trump gave was the idea that companies should be able to sell insurance across state lines.

So, lets jump back to the question of state regulation. It turns out that regulations dramatically affect the performance of a pool.

Lets say Nevada regulations said the maximum deductible was $5,000 and California set it at $6,400. A pool in Nevada would behave differently from  one in California.

The goal of selling insurance across state lines requires that the Federal government becomes the primary regulator of insurance.

This is why I was complaining before the election. Trump's statement that he would repeal ObamaCare was different from his statement that he wanted companies to be able to buy insurance across state lines.

I am really sad that things are turning out the way that they are. But the only way we could free market heatlh care reform is if people spoke with one another. But there is no way that this could happen in the current political climate.

Trump plans to keep portions of Obamacare

My criticism of Donald Trump was that he did not present a coherent alternative to PPACA and I have yet to see anyone in the GOP talking about substantive health care reform.

In interviews with Wall Street Journal and others, Donald Trump said that he planned to keep key provisions of Obamacare.

This style of politics is precisely what happened in the Bush presidency. GW Bush made a few allusions to free market health care reform. There was never any serious discussion of alternatives. In the end, GW Bush dramatically expanded the role of the Federal Government in health care.

It is not too late. I still contend that, if a group of people met and discussed free market health care reform. That group could prevail.

But, as long as conservatives refuse to even discuss free market health care reform, we will have no option but to continue with PPACA and all of the inequities that PPACA creates.

American Needs a New Health Care Plan. The first step is to talk.

Funding health care is a business problem. It is not a political problem.

I've complained that Trump does not have a clear plan for repealing Obamacare.

This really is not a problem. As I said in the opening sentence. The solution should come from the private sector and not the president.

The big problem we face is that there are no viable business solutions on the table.

This is an easy problem to solve: A half dozen people could sit at a table. Talk about free market health care reform. They would write up and publish a business plan.

At this stage in the game the six people don't even have to be serious about starting a business.

The way I see this going is that group meets. The group draws up a business plan for funding health care. The group then creates an advocacy group for this business model.

Back in the 1980s I worked designing program for an insurance firm. I concluded that insurance fails to give us the health care that we need. This is easy to prove.

So, I created an alternative to insurance which I called "The Medical Savings and Loan."

This MS&L funds health care with a combination of savings accounts, a loan reserve and grants. The center piece of the plan is a new position called "The Health Care Advocate." The advocate replaces insurance agents and claims adjusters.

I created the MS&L as a mechanism for breaking apart insurance pools into individual accounts. A defining characteristic of the program is that the money flows from individual accounts to the health care provider.

This simple change opens up a huge debate about the nature of insurance. Since the money for care is flowing through individual accounts, the MS&L creates a better picture the health care that we need in our society.

It turns out that, in free society, the vast majority of people (over 90%) could self fund their care. The mantra of the MS&L is simply: "those who can self fund their care should."

The program has a generous system of grants to help those who cannot self-fund their care. The mathematical model I created indicates that the MS&L is likely to get more money to the people in critical need than group health insurance.

Since the money is flowing through individual accounts, the MS&L will restore the pricing mechanism in health care which will lower health care costs.

Of course, delivering health care is about people and not mathematics. The central piece of the MS&L is a position called "The Health Care Advocate."

The business model I want to create is for the advocate. The advocate replaces the health insurance agent.

The presentation I have starts with the MS&L as a mathematical model, but it ends up talking about the advocate and the human side of health.

Anyway, if there was someone interested in discussing health care reform, they could contact me. I have some wonderful ideas that could profoundly affect the health care debate.

The down side. I live in Utah, but I am willing to travel. If a person can guarantee a group of six people willing to discuss and work for free market health care reform, I would be willing to take out a loan to travel and meet the group.

The upside of living in Utah. We have great skiing. If people want to have a ski vacation and talk about free market health care reform when they are off the slopes. I could work that out. The only problem. The snow isn't here yet.

To recap:

• Trump does not have a plan for repealing Obamacare.
• Not a problem: Funding Health Care is a business challenge and not a political one.
• What needs to happen is for a group meet to create an alternative model for funding health care.
• The group would create a business model.
• After creating the business model the group would create a non-profit advocacy group to promote the model.
• The advocacy group would select a spokesperson. That spokesperson would go to TV stations and talk about the model.
• The spokesperson would meet with leaders in their state and might even go to Washington to meet the president and people in Congress.

Funding health care is a business challenge. It is not a political challenge. The first step to facing this challenge is for a group of courageous people to sit down and discuss alternatives to group health insurance.

There may actually be wonderful rewards for anyone who is brave enough to think.

Trump Does Not Have a Health Care Reform Plan

I suspect that Hillary will win the election.

This might be good for the nation. Folks on the left are finally waking up to the realization that both their party and their ideology are corrupt.

The Affordable Care Act is failing. A Hillary presidency might lead to a substantive debate about health care reform.

As I write, there is a growing possiblity that Trump might win.

I find this problematic because Trump does not have a health care plan.

Vague statements about repealing and replacing Obamacare is not a plan!

Obamacare is a fiendish piece of legislation that is difficult to repeal and can only be replaced if the people repealing the legiistation had a framework in hand for free market health care reform.

I am one of those people who read the bill before it passed. PPACA is tricky.

PPACA is regulated at the Federal level and implemented at the state level.

States spent billions of dollars implementing PPACA. Were Trump to simply repeal Obamacare, America would still be saddled with the state level apparatus.

It is true that, after a repeal of PPACA, individual states will begin working on replacements for Obamacare. But, without a framework for restoring free market health care, the state level legislation is likely to produce even worse results than PPACA.

The right wing talking point is that PPACA is a government take over of health care.

The truth is that PPACA includes a grab bag of goodies for the insurance industry accompanied by federal regulations that limit profits and are believed by progressives to make insurance more equitable.

Insurance companies want to keep those part of Obamacare that line their pockets while shunting off those parts which limit profits.

Local insurance companies are very good at manipulating state regulations. The insurance companies know the financial impact of each line of the local insurance code and have the financial resources to control the local political process.

This means that blindly repealing PPACA is likely to create a regulatory environment that is, for most Americans, even worse than Obamacare.

Recapping: PPACA is Federal legislation implemented by the states. Repealing the Federal Legislation leaves the state regulations. PPACA is a grab bag of goodies for insurance companies. Local insurance companies will keep those aspects of the bill that line their bottom line while reducing those that do not.

To restore free market health care, one needs to create a framework for the repeal that will actually create free market institutions.

I created "The Medical Savings and Loan" to serve as such a framework.

In this work, I create an alternative to group health insurance called "The Medical Savings and Loan." It funds health care through a combination of Savings, a Loan Reserve and Grants. A key figure in this program is a new position called The Health Care Advocate who replaces the insurance agent and claims adjuster.

This structure is uniquely suited to discussing the difference between health care delivered through a collective mechanism such as insurance and socialism. It also provides people seeking free market health care reform a frame to discuss such reform.

NOTE: I developed this presentation a long time ago, but have yet to find an audience interested in the topic. I live in conversative Utah. Conservatives tend to suppress discussions of ideas.


I do not consider my presentation a panacea. But I have studied the issue in sufficient depth to know that we cannot restore free market health care just by waving the "repeal" wand.

To restore free market health care, we need leaders willing to discuss free market health care. I have yet to see anyone in the Trump camp discuss the issue.

I do not for certain that, without a framework for restoring free market health care. Simply repealing Obamacare will make things worse.

I figure that the best hope for repealing Obamacare is for Hillary to win and maybe liberals will finally realize that they've been duped and that the best way for providing care starts by talking about the issue.

Big Business and State Lines

For years I've wondered why conservatives have been so insistent on allowing companies to sell insurance across state lines.

Prior to Obamacare, Insurance was regulated by the states. State by state regulations would determine the behavior of health pools. A health pool in Utah behaves dramatically different from one in California. To be able to sell insurance across state lines, insurance would need to be regulated at the Federal Level.

Perhaps this is the reason:

In our present system health care is socialized at the employer level. In this bizarre system, employers place the health care resources of their work force into a single pool. Employers can then leverages the health care of their employees for political and economic gain.

Wall Street and big business see the United States as a single market. Big businesses like to have entities in multiple states to grab as large a share of this market as possible. When big business seeks to expand nationwide they have to set up separate health care pools in each state. This reduce their ability to leverage health care.

Regulating health care at the Federal level (so that insurers could sell insurance across state lines) would allow Wall Streets and Big Business to consolidate the health care of their employees into a single pool that would have greater leverage.

Unlike conservatives, I prefer small business and local control. I have so thoroughly broken with The Tories conservatives that I even question the wisdom of socializing health care at the employer level. Giving employers control over the health care resources of their employers creates a situation where employers can act like the feudal lords of old.

Speaking of Feudal Lords. Did you know that the grand ideology of Conservatism was created by King Williamn IV in the 1830s as an effort to rebrand the Tory Party in the wake of electoral reform.

The goal of Conservatism (The New Tories) was to preserve the social structure of the feudal system.

The Tories (also known as Conservatives) favor socializing health care at the employer level because it creates a class society with a distinct employer class that owns the resources of the nation and a working class that lives from hand to mouth dependent on the benefits given by the employers.

In the old world conservatives still proudly bear the name "Tory." In the United States, Conservatives are whimpering cowards who simply deflect conversations and refuse to engage in open debate about health care policy like the slimy little worms that conservatives are.

The issue of "buying insurance across state lines" is a perfect example of the way that Tories engage in conversation. Insurance is a regulatory product. Health care pools behave according to the state regulations. The great conservative cause of "buying insurance across state lines" means transferring control of insurance from the state to the federal government.

Conservatives will speak about state's rights in one sentence then demand the ability to buy insurance across state lines in the next (failing to mention that the sentences are are contradictions). Conservatism today is as flawed and corrupt an ideology as it was in 1830s when the Tory Party changed its name to "The Conservative Party."

The conservative cause of buying insurance across state lines means the creation of a single health care market controlled by central bankers on Wall Street with even less local control than we have today. Trump and his conservative followers are marching in the wrong direction.

Health Empowerment Accounts

For the last eight years I've held that, if a group of people engaged in a serious conversation about free market health care reform, that group of people could have a decisive effect on the heatlh care debate.

I've been been perplexed by the unwillingness of Conservatives to discuss free market reforms and had given up on the GOP.

However, I was delighted to hear Doctor Ben Carson mention the words "Health Empowerment Account" before the moderator cut him offer and diverted to less pressing concerns.

I was astounded. A word about free market health care reform was spoken in public and, just maybe, some people somewhere started thinking about the issue.

Maybe some people asked themselves: "What is a Health Empowerment Account"?

1. How can an account empower people?
2. How is a "health empowerment account" different than a "health savings account"?
3. Why did the moderator cut Ben Carson off?
4. Why haven't any other conservatives discussed free market health care reforms in the last eight years?

I actually do have answers to the questions above. Let's answer the easy questions first. Going in reverse order:

4) The moderator cut off Ben Carson because conservatives (and members of the GOP Establishment) do not want the American people to discuss free marketh health care reform.

3) Conservatives don't want Americans to discuss free market health care reform because true free market reforms would hurt the insurance industry.

Conservative opposition to free market reform is itself a very interesting story. For this paragraph I will simply state that Conservative think tanks are often funded by insurance and the goals of Conservatism and Big Insurance companies are closely aligned.

This thing we call ObamaCare (PPACA) is a network of state run health exchanges. The structure for the health exchanges was created by a Conservative group called "The Heritage Foundation." The basic idea is that the industry could improve coverage if the state were to combine insurance mandates with regulations that forced insurance companies to provide coverage for pre-existing conditions.

The Heritage Foundation believed that insurance mandates might help it achieve a variety of conservative social goals. After all, the group that controls access to health care can control the people.

2) Conservative have a long history of passing legislation that benefits insurance companies. The system of Health Savings Accounts is a prime example.

The HSA program gives a tax credit for money put aside in a "Health Savings Account." My first observation is that only people with large incomes benefit from the tax credit.

An HSA is usually given in conjunction with high deductible insurance policy. The high deductible frees insurance companies from having to process small claims for day to day care.

The pernicious effect of the HSA is that only upper income employees benefit from the tax credits. Lower income workers simply receive health coverage with high deductibles which they cannot afford to pay. While it is true that low income workers with no children and no health expenses can benefit from an HSA, the HSA model artificially decreases the income of low income with children and those with health expenses.

The HSA model was created by the insurance industry as an add on to insurance to benefit insurance and people in upper management. The fact that one model built around savings benefits the rich does not mean that all models will benefit the rich.

1) This is why I was excited to hear Ben Carson mention the words "Health Empowerment Accounts" during a public debate.

I believe strongly that, if one built the health care system around a health account that one could create a system that empowered people to take control of their health.

I am not an expert on the Ben Carson plan. Okay, the only thing I know about the Carson plan is that it starts by giving each person an account that is used to track their personal health savings and expenses.

I know that this statement will sound weird at first. But this simple step of giving people an account to track their savings and expenses would fundamentally change health care in America.

The current health care system is built on a collectivist model. In the current system, health care is provided at a group level through insurance companies. Insurance companies collect premiums for care to build a health care pool. The insurance company tracks the expenses of the pools and the wealthy investors speculate on the pool. Claims adjusters within the pool determine who receives care and when.

For more information on the philosophical model behind insurance. I suggest reading a rather dense tome titled "Das Kapital" by a nineteenth century thinker named Karl Marx. (I never really understood insurance before I read this work by Marx who could rightfully be considered the founder of modern insurance).

And yes, I did just state that employer based healthc are is socialization of health care at the corporate level. From a mathematical point of view, there is little difference between health care collectivized at the employer level and health care collectivized at the state level.

The most direct path to breaking apart a collectivized system is simply to start tracking expenses at the individual level.

The money for health care could still be in a pool. The simple fact that the system is tracking the health of individual people and not collective health would fundamentally change the system.

The simple fact that individual accounts would allow individuals to start seeing their health as their concern would dramatically change the health care system and health in this nation.

I admit, I am part of that radical fringe who wants America to take the anti-social step of removing some of the money from insurance pools and giving individuals greater direct control over their health care dollars.

Like other free marketeers, I have a tendency to jump of ahead of myself and start talking about how our society would appear if there was a more equitable distribution of capital. (Hint there would be more small businesses, less big businesses, a more equitable distribution of income, and healthier people.

People are so cowed by big insurance that, at this point in time, people are in capable of imagining health care without huge pools.

But, if they had direct access to information about their personal health, people would start to realize that they would be better off with direct control of their health care dollars.

Anyway, I was really excited to hear Ben Carson say the word "Health Empower Account" on the TV set before being cut off by the moderator.

My head has been spinning with all of the possibilities that could take place if there were people brave enough to talk about free market health care reform.

Now, both Ben Carson and Rand Paul seem to be out of the running for this presidential race. None of the other GOP candidates seem to have any interest in free market health care reform.

I can't imagine a debate about free market health care reform taking place in this political cycle; So, I admit I am somewhat at a loss as to where we should take this debate.

Dr. Carson's system of "Health Empowerment Accounts" would go a long way to restoring freedom in America. I think what we have to do is discuss why recording health information on an individual basis would change health care and work to differentiate this idea from Health Savings Accounts. Above all, those seeking to advance free market reforms have to counter this fiction that Conservatives support free market reforms, when the truth is that conservatives actively silence discussion of such reforms at every step. Just hearing a person mention a word in a debate before being silenced should be enough. But I can't figure out where to proceed with that.