Try the extended warranty for health care

Health care today is run like My Favorite Mechanic.

That's where I go to get my car fixed. Something breaks, I go in.

I don't really help my mechanic's business model. I go in for regular oil changes, so I seldom face major repairs. Major repairs are a mechanic's meat. Engines, transmissions, and big brake jobs are where the big bucks are.

Medicine works in the same way. It's not built around maintenance. It's built around fixing what goes wrong.

Efficiency would mean changing the business model, from one where you pay for sickness than one where you pay for wellness.

You were offered this whenever you went to the late, unlamented Circuit City store in your town and bought something.

It was called the Extended Warranty. And it was, usually, a joke.

But that's the best model for health care.

Stop setting the income bar at zero and get the meter going each time a patient needs something done. Set it at a reasonable level, enough to pay for regular visits, for wellness coaching, even some psychiatric counseling. Then put everything else out for bid.

Suddenly your incentives change. You want to make those regular visits, your doctor is expecting to see you, and we can then start in with bonuses for those who keep people out of the hospital.

Hospitals would have an incentive to keep costs down, because if they're the high priced spread they're not going to get any work, except from the elite who opt-out of the system. Lawyers will make their money proving doctors cut corners to get low bids, rather than for the occassional oops.

This is basically what Dr. Ralph Snyderman was talking about last month at the Emory-Georgia Tech Predictive Health Conference. It's those who pay the bills who have to demand this change, because they will reap the greatest benefit.

Pay to make certain the machine runs well and you won't have so many costs down the road. My mechanic tells me this. Your doctor should have an incentive to do it too.