Health Care Question

I recently moderated a panel on health care for the Dartmouth Minneapolis Club. It was very good. Minnesota companies are doing some interesting things, including some vertically integrated health care delivery models that are very intriguing.

But a point came up about end of life expenses, with a president of a hospital lamenting on how much can be spent to maintain a few extra months of someone's life -- we all know the stories on this. And yes, the question arose from someone who was concerned about death panels. The hospital president was pitching living wills to deal with this problem.

I responded with this question: If I create a living will for myself that will limit the medical options to be used for me in certain end-of-life situations, should I get a lower price for my health insurance?

Note that the Senate Finance Committee bill will allow health insurance policies offered through their exchanges to differentiate prices based only on age, family size, and tobacco use -- and with maximum increases that can be applied for any of these situations.

Someone else on the panel wanted policy prices to be lower for folks who use seat belts.

If we recognize lower cost of health maintenance for people who don't smoke or use seatbelts, why not for people who voluntarily limit their access to some of the most costly medical technology?

I have always thought that the free market solution to the health insurance problem would give people choice in their coverage to a much greater extent than the policies available today. Such choices would have to limit a person's ability to access certain kinds of care in certain situations, such as my end-of-life example. Other ways to do this would be to accept a process for determining what procedures, devices, drugs are deemed to be cost effective. That sounds like death panels -- let a panel decide whether a procedure will be authorized -- but the difference is that individuals would be making the choices themselves and getting the benefit of lower prices.