Why health insurance reform bothers me.

For many decades, the process and definition of healthcare delivery (what it means to receive healthcare) has been intimately tied to how we pay for healthcare. The government (Medicare) defines what they pay for (this kind of office visit, procedure, device, or medication for this certain diagnosis). And the private insurance industry follows suit.

Things happen in healthcare in response to the money. And profitability isn’t always what’s best for our nation’s health. Now that we’re more centralizing the healthcare delivery and payment decision-making, we become dependent upon the government’s definition of healthcare– how it should be delivered and how it should be paid for. Even more importantly, we become dependent on the government’s idea of innovation.

Any deviation from the status quo will now be a pilot project executed with the passion of a bureaucrat.

Our culture changes rapidly. Industries have been entirely changed by the internet in the last 15 years. The healthcare industry has remained almost untouched. Why? Because the money and delivery of healthcare has been under the control of Medicare and the private health insurance industry. Eighty-five percent of Americans have health insurance, and are stuck in the current, inefficient delivery and payment processes. Fifteen percent (nearly 50 million people) are not. 

The only way to experiment with radical new ways of delivering and paying for healthcare (the only kind of innovation that will get us out of this mess) is with the 15% of people who don’t have health insurance. That’s where we can create products, services, and more convenient, effective processes that meet the needs of true healthcare consumers. Because if they don’t like the experience their money buys, like every other consumer industry, they’ll take their money elsewhere. 

In essence, the cash market of healthcare is where we can create better processes that meet the real needs of true consumers.

I fully support the government bailing out individuals who face financial ruin due to medical bills. They’ve bailed out banks and car companies. Why not bail out people who declare bankruptcy due to medical bills (62% of people declare bankruptcy due to medical bills…80% of those people had health insurance)? Nobody should go bankrupt because they can’t pay for needed medical care. That’s what true insurance is.

Health insurance is not deciding what healthcare is, how much it should be reimbursed, and then micromanaging each individual’s health experience.

Since the government has led the charge for the past 50 years for 85% of our population deciding that doctors should be paid for sickness, there have been very, very few realistic opportunities for competing business models that focus on paying doctors for wellness.

And paying doctors for wellness is exactly what needs to happen in order to create a sustainable healthcare system that works for all of us for an indefinite time.

Health insurance reform has indefinitely locked us in this unsustainable, unjust, poorly distributed profit-driven sickness paradigm. And now that the government is trying to eliminate the potential to experiment in a free market by mandating that everyone purchase the sickness model, half-baked bureaucratic pilot projects are our only hope to change things and truly make healthcare awesome.

We’re America. We make awesome stuff. That’s what we do. That’s what we have done. Our country was founded on the freedom to make awesome stuff. And that’s why we may not always be loved, but we’re always respected.

So let me be an American. Let me experiment. Let me create awesome new ways to deliver and pay for healthcare so you can be healthier and happier. Let the healthcare space be as vibrant as the internet startup space. Lay down a platform for experimentation and disruption and set us free to create new business models for purchasing health. But please Mr. Obama, protect vulnerable people from financial ruin. Beyond that, stay out of the examination room and the minutiae of defining the constantly changing thing we call healthcare. You move too slowly. We’re trying to move fast responding to people’s health needs by creating awesome stuff.