I think you could liken health insurance more to a combination of your State Farm policy and your manufacturer’s warranty. Now of course your warranty does not cover gasoline, but there are a lot of auto manufacturers who do cover the cost of scheduled maintenance for, let’s say, 30,000 miles.

In regard to high-deductible health plans, they definitely have their place. (I don’t think they’re right for me, but they can be good for people who are healthier and/or wealthier.) But our HDHPs have 100% coverage for preventive care. You can debate the merits of that if you want.

But the value that a lot of our members find is that they get huge discounts for using in-network providers. As you point out, the doctor charges 250% of what he will actually collect…because the insurer requires him to accept less. But what if there were no insurer requiring that? Then YOU would get stuck with the full charge. This happens to uninsured people all the time. How would your proposal resolve that?

Also, one of the more important things we do as a company is to enforce standards of care. But if insurance companies excluded primary and preventive care coverage altogether, then there would be no enforcement and doctors could just do whatever they wanted (and whatever they wanted to charge for). I have talked to enough patients to know that they trust their doctors implicitly…sometimes at their own peril. And patients rarely understand standards of care. So where would we find the checks and balances? How would we measure quality? etc. etc. etc.

I thought you might want to mention it to your readers.

I especially enjoyed his pointing out the moronic argument made by the Boston Globe who thinks we shouldn’t let highly-skilled foreigners immigrate to the U.S.

Why? Because it wouldn’t be fair to their native lands. (That part they state explicitly).

But, Why? Because, um, well, the talents and skills of people are the property of whatever state they happen to be born in. It wouldn’t be fair to that state to let their property just wander away, now would it? (This part they only imply; but, what else could it possibly mean?)

We had a similar problem 150 years ago. We solved it with the Fugitive Slave Act. Valuable cotton-pickers had to be returned to their legal owners forthwith.

The Globe wants us to take the same attitude today. Sort of a professional courtesy owed by one slave-master to another.

As for big-ticket covered items like angiograms, insurers should be allowed to provide other kinds of incentives for consumers so they always seek the lowest priced provider with acceptable quality. For example, if angiograms of appropriate quality were priced in a range from, say, $5,000 to $15,000, and the insurer’s average payment has been $12,000, the insurer might offer to share any savings below $12,000 with the patient. Thus, the consumer who obtains the $5000 procedure might get a check (or HSA contribution) from the insurer for $3,500, or half the $7,000 savings. Thus, the consumer makes out, the insurer becomes more profitable and/or competitive, and the most competitive provider succeeds in gaining market share.

My book (Cured! The Insider’s Handbook of Health Care Reform) is now available for preview online at Google Books. If you’re interested in a more detailed example of how such positive incentives could bring down health care costs, I invite you to read the free book excerpt at http://books.google.com/books?id=R1wWvnjCswcC&lpg=PA6&ots=XBxOWjg77C&dq=Insurance%20coverage%20for%20primary%20and%20preventive%20care%20saves%20money%20by%20preventing%20expensive%20diseases%20stephen%20hyde&pg=PA389#v=onepage&q=&f=false.

Once that deductible is reached, all the other medical costs for the year (the gas and oil costs) get paid by the insurance. This can lead to abuse and waste.