The power of paying for health care

The insurance company hired by my employer has been trying to bribe me into abandoning a business person with whom I have developed a relationship of trust over a period of years.

The business person is my local pharmacist. I take a number of medications regularly to keep my blood pressure within acceptable limits. The cost of these medications is about $135 a month. The reason I know this is that last year, I stopped using the prescription drug benefit provided by my employer.

The insurance company will cheerfully reduce my monthly expense to $60. All I have to do is end my relationship with the local pharmacist and instead use a mail-in service, which coincidentally is operated by the insurance company.

Fortunately, for now I'm in a financial position where I can afford to make up the difference. But no doubt there are hundreds of thousands of people who have come to depend on their employers' subsidy of their medication and cannot take that kind of hit, so they give up the right to look their medicine supplier in the eye, ask questions and kibitz about sports or the fate of the nation.

I'll tell you, though, it actually feels empowering to pay full freight for those pills. The reason is simple: I now have control. I decide who pockets the money and who provides me the service. As long as I can afford it, it's worth the extra $75 a month to me.

It also may be better for me in the long run: My doctor would like to get me on yet another expensive long-term prescription, but since I'd be paying for it I finally have been starting to work on the diet and exercise advice she gave me a long time ago, the advice she said would help me avoid the new medication. My interest in saving money this way likely will benefit my health in the long run.

And there, I think, is the solution to our health care cost crisis. When someone else pays the bills, you don't really pay attention to the cost, and so the payee really has no incentive to keep the cost under control. The "someone elses" of the world are now raising their own prices to a level where the rest of us are growing alarmed. It seems counterintuitive, but I suspect if we all had to pay full freight, the drug companies and doctors and everyone else in the health care industry would start getting serious about providing excellence on a more cost-effective basis.

I'm not advocating that, mind you - so many years have gone by under the current system that most of us couldn't afford suddenly being required to pay full freight. I'm just stating it as a personal goal. In a sense this is the price for staying alive, so I don't mind paying the bill as opposed to having a couple of fancy meals or new DVDs and other toys.

And I'm aghast at what the state of Maryland is about to impose: A law that requires employers to spend a minimum of 8 percent of their payroll costs on health care. Aimed at Wal-Mart, the law is being pushed as a way to keep Medicaid costs down (while having the added "benefit" of punishing the eevil Wal-Mart empire).

But what it really does is say that if an employer finds a way to provide adequate health care coverage for its workers for, say, 5 percent of the total payroll, it will be in violation of the law. And should an employer feel motivated to give its workers raises - to give the workers greater economic power - it has to be careful that those raises don't reduce the health insurance contribution below 8 percent.

I don't pretend to be an economist, but my instinct is that this latest attempt by a government to run businesses is going to do more harm than good in the short and long terms. It seems to me to be just another artificial way to keep health care costs rising.