A Physician’s Template for Healthcare Reform: An Eleven Point Plan
Jane Lindell Hughes, MD, FACS, San Antonio, Texas
Edited and Adopted by the Founders of AmericanDoctors4Truth
There are those who say that ObamaCare is now the law of the land and we as citizens should accept it and proceed with compliance. However, the overt bribery with cloistered deliberations and the failure of Congress to read the bill prior to passage are an affront to every American citizen regardless of political persuasion. As we now begin to understand this takeover of one sixth of the private sector economy, we see a fundamental transformation of the relationship between the individual and the federal government. The profession of medicine has been politically commandeered to accomplish centralized power in government bureaucrats who now have the potential to intercede in some of life’s most critical and intimate affairs. Between the State Exchanges dispersing 61 pages of personal medical and private financial information to five federal agencies, and the IPAB (Independent Payment Advisory Board) which will have life and death rationing capabilities, this law literally allows government intrusion into all aspects of our lives.
These ideological considerations aside, many promises of ObamaCare have been shown to be false. It will not lower healthcare insurance costs which have already risen. With full implementation at least 30 million Americans will still be without insurance, many of whom will have had it prior to ObamaCare. Access to quality care will actually be diminished with the increased demand for “free” services and additional people forced into Medicaid. Furthermore, using Medicare and Medicaid to evaluate how the government handles healthcare insurance, without intervention Medicare will be bankrupt as early as 2020 and Medicaid is paying $0.60 on the dollar for care rendered to its enrollees. It is now estimated that ObamaCare will cost $1.7 trillion in the first decade and $1 trillion per year after that. With almost $17 trillion in existing federal government debt, the fiscal aspects of ObamaCare, not to mention the regulatory stranglehold on the medical industry, are not feasible and are financially ruinous for our country. Where do we go from here?
Attention has now turned to the States, where 26 have rejected setting up the State Exchanges. The expansion of Medicaid is also meeting resistance, as many states are already struggling with the exploding costs associated with it and the uncertain reliability of future federal funding. These two actions alone have already delayed the full implementation of ObamaCare, presenting a window of opportunity for non-government solutions to fix our American healthcare system without destroying arguably the finest medical and surgical care in the world. Already across the country physicians in concert with business and insurance are crafting private care networks with health savings accounts and catastrophic health insurance. In my opinion physicians have the answers but we have been without a clear voice that articulates what needs to be done and how to accomplish it. The AMA, which supported ObamaCare, and their $80 million code book government contracts is not that voice, representing only about 12% of practicing physicians. Currently, Docs4PatientCare, The American Association of Physicians and Surgeons, AmericanDoctors4Truth, and Physician’s Council for Responsible Reform are leading activists in this endeavor. I am actively involved with all four and have an informational website on healthcare issues, usaHealthAlert.org. Most of the reform ideas emerging share the common philosophy of patient centered, physician guided, free market driven reform. We don’t ask lawyers how to fix a space station and we don’t ask politicians to solve theoretical mathematical models. We go to the experts who understand the system and what makes it work, or not. The time has come to get the physician’s voice out in the forefront of healthcare reform. We have the answers. When ObamaCare collapses upon itself, perhaps those in Congress who truly care about real reform will consider asking the experts, the boots-on-the-ground practicing physicians who take care of you and your family. The twelve points for reform are as follows:
- Get employers out of the health insurance business by replacing insurance purchase with a defined contribution for healthcare. Massive administrative costs from the yearly changing of plans would be saved and disruptions to existing physician relationships would be stopped. This would enable individuals to purchase their own personalized healthcare insurance not tied to a specific job. The insurance industry would respond with a robust offering of individual policies that would pool risk and compete by virtue of the value of their product, not contracts with third parties.
- Allow individually purchased health insurance and Health Savings Accounts to be tax deductable.
- Allow Medicare aged individuals to opt out of Medicare without penalty in return for a defined contribution allowing individual purchase like the rest of the population. This will work if the system is reformed to offer competitively priced individually held insurance products. Set a time frame for Medicare phase out with Medicaid retained for the indigent of all ages.
- Medicaid would emerge as the only federal government healthcare program for the truly indigent or disabled. It could also serve as stop-gap insurance for those between jobs who could not afford continuation of their insurance, as well as a “rider” for pre-existing disease added to conventional insurance for a specified time period. States should receive block grants for Medicaid funding to decrease the perverse incentives to increase enrollment and to promote innovative ways to ensure access to care in cost effective ways.
- Return to insurance model of shared risk for unanticipated medical or surgical expense related to illness or injury. The notion that insurance is pre-payment for routine and preventive healthcare cannot be fiscally sustained. Pre-tax funded health savings accounts could be used for routine and discretionary healthcare costs. Many current insurance payments exceed the cost of routine care and a major medical policy.
- Encourage states to eliminate insurance coverage mandates for non-essential non-medical coverage (acupuncture, therapeutic massage) to lower costs. This would allow affordable catastrophic coverage. Individuals could then menu price additional coverage as needed or desired. Pre-existing condition “riders” could be on that menu or through Medicaid.
- Allow purchase and portability across state lines. This would increase competition. States are the place for innovative healthcare solutions, not one size fits all centralized control. Mistakes are also more readily remedied.
- Each physician should develop his or her own single fee schedule for all patients regardless of their insurance. These fees should reflect services rendered and resources used. This could be available through state portals allowing patients to cost compare. Transparency would be restored. Cost shifting and horrendous administrative costs would be eliminated. Contracts between physicians and third parties would be phased out, in concert with the shift to individually held policies.
- Apply the same transparent public fee list requirements to hospitals, laboratories, pharmaceuticals, and medical device companies. This would eliminate cost shifting, burdensome administrative requirements, and would allow physicians and patients to make informed choices.
- Enact tort reform to reduce the estimated 30% healthcare and drug costs related to fear of bogus litigation.
- Allow the cost of charitable care to be a tax deductible item by the physician. The Medicaid fee schedule could be used with a reasonable limit on yearly deductible amounts.
Adopted by the Founders of AmericanDoctors4Truth:
Ori Hampel, M.D.
Kristin Story Held, M.D.
Jane Lindell Hughes, M.D., FACS