A Physician’s Template for Healthcare Reform:
An Eleven Point Plan
Revised Edition, March 17, 2015
There are those who say that ObamaCare is now the law of the land and we citizens should accept it and proceed with compliance. However, the overt bribery with cloistered deliberations and the failure of Congress to read the bill before passage is 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 bureaucrats who now have the potential to intercede in some of life’s most critical and intimate affairs.
These ideological considerations aside, many promises of ObamaCare have been shown to be false. Health insurance costs have already risen and individuals have lost policies , hospital access, and physicians with whom they were happy. Access to quality care for those on Medicaid has further declined. Medicare, Medicaid, and the VA are existing examples of government medicine. Medicare as it is will be insolvent by 2020, Medicaid pays less than the cost of delivery of care for many services, and the VA scheduling delay scandal actually cost lives. The King vs Burwell legal challenge may further doom this misguided law.
Thirty-six states wisely rejected ObamaCare by not setting up state run exchanges. Of the fourteen that did, at least seven are now insolvent after over a billion dollars of federal tax dollars were spent to help set them up. ObamaCare has never been implemented. Rather, it has been changed by administrative or executive fiat at least thirty-five times. After the 2014 elections, there is now a window of opportunity for non-government solutions to fix our American healthcare system without destroying arguable the finest medical and surgical care in the world. Across the country physicians are joining forces to craft viable alternatives that fulfill the false promises of ObamaCare. Although the AMA has name recognition, it represents only about 12% of practicing physicians. In fact, the AMA supported ObamaCare because it has a monopoly on the coding books necessary for business with government insurers, an estimate $80 million a year revenue for them. Currently Docs4PatientCareFoundation, The American Association of Physicians and Surgeons, AmericanDoctors4Truth, The Physician’s Council for Healthcare Policy, and The National Coalition of Physicians for Healthcare Freedom are leading activists in these endeavors. Most of the reform ideas share a common philosophy. Our system should be patient centered, physician guided, and free market driven leading to healthy competition and free patient choice. 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 these systems and what makes them work or not. Perhaps those in Congress who truly care about enduring reform will consider listening to the experts in healthcare, the boots-on-the-ground practicing physicians who take care of you and your family. The eleven points for reform are as follows:
- Get employers out of the health insurance business. Shift insurance purchase for the employee to defined contributions for healthcare purchases or to increase wages to place individuals in the driver’s seat selecting insurance options that fit their needs. Massive administrative costs for business would be saved and disruptions to existing physician relationships would be stopped. Insurance would be non-job specific and portable. The insurance industry would be forced to respond with a robust offering of individual policies that would form the risk pools. They would compete by virtue of their product, not contracts with third parties.
- Purchases of health insurance, a health savings account, or direct care are done with pre-tax dollars regardless of who makes the purchase. This encourages preventative care, good stewardship of healthcare dollars, and is the best fraud and abuse protection.
- Once a robust individual market is established, liberate Medicare aged individuals by allowing them to opt out of Medicare without penalty. A defined contribution would allow them to purchase insurance of their choosing like the rest of the population. Retain Medicaid for the truly indigent or incapacitated of all ages.
- Medicaid would emerge as the only federal government health insurance program, except for the Military and the VA System. (Their reform is for a different discussion.) It could be also used as a 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. States should receive block grants without mandates to decrease the perverse incentives to increase enrollment. This also promotes innovative ways to ensure access to quality care in cost effective ways.
- Return to indemnity insurance where there is shared risk for unanticipated medical or surgical expenses related to injury or illness. The notion that insurance is pre-paid routine healthcare cannot be fiscally sustained. Health Savings Accounts with a catastrophic insurance policy paid for with pre-tax dollars (whether employer defined contribution or individually purchased with higher wages) would transition to paying health care dollars, not insurance dollars. Many current insurance payments exceed the cost of routine care and a catastrophic policy.
- Encourage states to eliminate insurance coverage mandates to allow a catastrophic policy and HSA’s. Pre-existing could be covered with time limited riders.
- Allow purchase and portability across state lines. States are the places for innovative healthcare solutions, not one size fits all central planning. Mistakes are more readily remedied as well.
- Total transparency across all health care entities is essential. No more third party contracts. There could be a state sponsored portal where hospitals, pharmacies, physicians, etc could post their individual fee schedules regardless of the insurance the individual carries. The insurance contract then becomes one between the patient and the insurance company. The other entities likewise would have their contract with their patients who are their true customers. Insurance companies then could list what they will pay, not dictate what the physician can charge. This allows patients free access to whatever provider they chose. Cost shifting and horrendous administrative burdens would be eliminated. Prices would fall as competitive markets emerge. We don’t walk into a grocery store and get charged different prices depending on what credit card we use and what deal they have with the grocer.
- Fees and costs should reflect the cost of resources used and services rendered, not an inflated price upon which third party contracts base their “discounts” for individuals in their “network”. This allows patients and physicians to make informed decisions regarding health care expenditures and choices.
- Encourage states to enact tort reform limiting pain and suffering awards while allowing reward for lost wages and function. This would reduce the estimated 30% added on healthcare and drug costs related to fear of bogus litigation.
- Allow cost of charitable care to be a tax deductible item by the physician. The Medicaid fee schedule could be used with a limit on yearly deductions.
Jane Lindell Hughes, MD, FACS
Edited and Approved By:
Kristen Story Held, MD
Jane Lindell Hughes, MD, FACS