Keith Smith

We hear the “repeal and replace” slogan a lot. Pundits such as the socialist editorialist Clarence Page have called Republican leaders out, Sen. Mitch McConnell in particular, for not having a replacement plan for ObamaCare if they can manage to repeal it.

This very short-lived interlude, void of any more health care ideas from Washington, is refreshing, I think. Unfortunately, I’m sure the GOP will soon spoil the silence. And can anyone believe that any answer coming from Washington wouldn’t be designed to line the pockets of the special interests at the table writing the bill?

I’m all for repeal. But let’s not stop with ObamaCare. Let’s move on to many disastrous legislative interventions brought to us from the other side of the aisle. How about Medicare Part D, rammed through in the dead of night by a GOP-led executive? How about the costly administrative nightmare of HIPAA?

We don’t need another massive Rube Goldberg contraption that claims to fix our problems. We need to repeal the laws that created the problems.

Why didn’t the GOP change the tax code to end the discrimination against individual purchases of health insurance during the time they had all the power? This tax reform isn’t likely, even though it would do much to relieve the problem of pre-existings as people could keep a guaranteed-renewable policy all their lives, instead of having to be underwritten again if they lose their job. Why not? Hint: The shift away from employer-purchased plans would gut the scam of PPO repricing, a devastating blow to the big insurance companies.

Most people don’t even know how “repricing” works. Insurance companies are perversely rewarded by seeking out the most expensive “providers” they can find. They subsequently “reprice” a bill of $100,000 to perhaps $28,000 and charge the employer plan a fee that is a percentage of the amount they have “saved” them—$72,000 in this example. Hospitals gladly produce these bills for their pals, as they can write the fictitious loss off as “uncompensated care” and bill Uncle Sam for a percentage of this number. Insurance companies agree to lock out certain competitors to garner the hospitals’ participation in this little scam.

Insurance companies make more money doing this than they do from premium collection! This money isn’t included in the calculation of the new MLR (medical loss ratio) requirements of the UCA (Unaffordable Care Act). This MLR only applies to premiums collected. Beginning to see why the big insurance companies wrote the bill this way? Administrative fees and PPO access fees are also not included in the MLR calculations.

Changing the tax code ends this scam. Individual policies (as opposed to group or employer-sponsored policies) are not subjected to “repricing” fees. You will know that the GOP is furious with the insurance companies when this tax reform passes. If the GOP threatens to pass it, then doesn’t, you will know that they did this to raise money from the insurance companies as extortion.

What would the reaction of the average working person be to the following from the GOP? “We aren’t advocating a replacement plan because this government is so completely compromised, corrupt, and incompetent that something as important as health care can’t be trusted to it. We are going to fade back and punt this to the states and let them unwind the insanity we have thrust on everyone in the country. Our gift to you is to remove ourselves from this issue entirely, rather than continue to sell our influence at your expense.”

Will anyone say this? Jim Jordan (R-Ohio) has gone further. He has recommended block grants. He has openly encouraged governors to ignore ObamaCare (nullification, anyone?). And he is circulating a petition that will commit legislators to deny funding to implement it. Most of the GOP will abandon the big money of the insurance lobby when “acting under their influence” (AUI) costs them their jobs. Others like Jordan are advocating a principled path, one we can only hope will attract the others.


Keith Smith

Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.

In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedures, a move that has gained him and the facility, national and even international attention. Many Canadians and uninsured Americans have been treated at his facility, taking advantage of the low and transparent pricing available.

Operation of this free market medical practice, arguably the only one of its kind in the U.S., has gained the endorsement of policymakers and legislators nationally. More and more self-funded insurance plans are taking advantage of Dr. Smith’s pricing model, resulting in significant savings to their employee health plans. His hope is for as many facilities as possible to adopt a transparent pricing model, a move he believes will lower costs for all and improve quality of care.