One by one the presidential aspirants in both parties are starting to share their thoughts on how to revamp our health care delivery system. All are looking for a needle in the haystack. The needle, of course, being a metaphor for an elusive solution to the vexing problem and hiding in an unlikely place. So far, in my judgment, all have missed the boat. Not every haystack has a needle–but some do, if you are willing to look hard enough.

The problem with the solutions revealed so far is that the focus is on the wrong part of our health care system. In one way or another all suggestions deal with the way we finance health care rather than the delivery system itself. The real problem is not so much “how” we finance, but “what” we finance. I do not believe we will ever reach a satisfactory solution until the system has been dissected and its component parts examined to see if there aren’t some needles that could show the way to a more effective and lower cost mechanism to deliver our health care–rather than continuous tinkering with the financing of the system as it is. There are such needles out there, if we have the courage to look for them. A few examples may serve to make the point (no pun intended).

Needle #1: Re-examine the way we cover (or finance) maternity benefits. Maternity does not meet all the tests of an insurable risk and was not fully covered in early health plans. It was treated as a loading factor and a benefit of $150 to $250 was added to the plan for maternity to essentially provide a benefit for younger workers who, through their premiums, were financing more serious illnesses of older workers.

But then came the mandates for various coverages, including maternity, and full coverage had to be provided. Is it a coincidence that since the advent of the mandated coverage, costs for maternity care have skyrocketed? I don’t think so. The option of a C-section delivery has multiplied, adding to the cost. Further complicating this picture is the prevalence of malpractice suits that has reduced, drastically in some areas, the number of practitioners.

Maternity is the one medical treatment where a person has time to plan and save for it. There must be a better way to handle this expense. The needle is out there.

Needle #2: Examine the cost impact of illegals on our health care system. If we, as a nation, have decided that, for humanitarian reason, no one, legal or not, within our borders should be denied essential care, is it proper that much of that cost be borne by people who carry health insurance? This is blatant cost shifting from the uninsured to the insured. To the extent such care is paid for by the government it is usually at the state level and disproportionate load is paid by the border states. Perhaps such humanitarian assistance could be financed separately rather than by premium increases on the insured and local taxes. A national policy should distribute costs over the entire nation–not just the impact states.

Needle #3: Examine carefully the way we handle capital expenditures used in the health care system. Should expensive equipment and technology used by all patients be paid for largely by insured patients? Is the distribution of high tech equipment overdone, or are we short of what we need? Some years ago I recall a move to prevent duplication of expensive equipment in hospitals within a certain geographic area. I have not heard much about that lately. What is the current status?

Needle #4: Examine more thoroughly the relative merits of lower cost alternative medicine and preventative care. Many such options are not now covered–forcing people into more expensive care that is covered by their insurance. I understand that preventative care may not save money in the short run–but it does extend life and sometimes avoids more costly treatment in the long run.

Needle #5: Perhaps the most important of all. Consider a new system for compensating people that may be injured by medical treatment. Litigation associated with today’s tort system is time consuming, expensive and does not render benefits evenly among claimants. It is a system whose primary beneficiary is the horde of personal injury lawyers, rather than patients. Perhaps a system similar to workmen’s compensation could be devised thereby eliminating most, if not all, the litigation now practiced. Medical practitioners and hospitals could pay premiums into the plan in lieu of malpractice insurance. Participants’ premiums could be experience-rated providing incentive for safe practices. The elimination of most, if not all, lawsuits should reduce the incidence of “defensive medicine” now practiced–a big cost factor.

These are but a few needles that metaphorically may be lurking about in the haystacks. I do not have a lot of hope that any of these needles will ever be found. In their pursuit to be nominated or elected it is much easier for politicians to demonize the health insurance industry than rummage through a haystack looking for the elusive needles that could bring down the cost of “what” we insure.