Solutions for health care costs

Americans without Medicare insurance have become the driving issue in the debate over health care reform. But those uninsured people aren't always victims of the system.

Some of them are also pioneers in what could become the future of the health care industry. Because they pay out of pocket, many uninsured persons have become skilled price shoppers.

That is also true for Americans with "high deductible" insurance coverage that requires large personal outlays before paying for health services. This health consumer trend should not be discouraged by public policy. On the contrary.

There now are Web sites where doctors and hospitals willing to negotiate with patients can post their prices and where consumers can report and compare health care prices. The Center for Studying Health System Change reports initiatives and experiments around the nation aimed at providing consumers more information on the quality and costs of health care. It also reports that insurance companies are developing lower-cost, less-comprehensive products in response to consumer market demand.

The move toward a more consumer-oriented model of health care pricing stands in sharp contrast to existing practice under most private and government health insurance plans. The New York Times describes the current model as "a quagmire, oozing with jargon and ... procedural terminology codes" that rarely results in a standard price for a medical treatment. Instead, "it is not unusual for a provider to have 10 or more different prices for the same procedure," depending on what has been negotiated with insurers. People paying for themselves usually get a much higher price quote.

Price shopping by people with high out-of-pocket health care costs could help change that inequitable system. And that would be a beneficial development for the nation's health care industry.

The high political stakes -- and the complex political machinations -- surrounding the push for health care reform understandably attract considerable publicity. Such was the case again Monday as the president and the Senate's Democratic leadership scrambled to placate some of their own party's moderates who are rightly wary of the long-term costs of the sweeping changes being pushed.

But if health care reforms are to be sustainable, they must offer practical, cost-cutting innovations. And like the well-documented examples of communities that have found a variety of different ways to lower medical expenses, individual initiative shows that progress toward a more efficient system is possible even under the current, flawed system of insurance paid for by employers or the government.

The proper aim of health care reform should be to encourage beneficial trends, not to create more red tape.