There has been unprecedented negativity surrounding healthcare for more than three years. Much like our combat missions overseas, Americans are growing weary of this issue. They have been fed a steady diet of rhetoric from the left and right and are confused about what to believe, but polls indicate that the majority of Americans wish to see the Affordable Care Act repealed. The entire country is anxiously awaiting the Supreme Court decision, which will determine what comes next for healthcare.
What if we could magically erase everything and start again? What would we do to make a healthcare system that would work for the majority of Americans? Doing so would entail tackling the same problems that President Obama claimed to be solving, but failed miserably at- high costs and problems with access to care. But it would take more than this. It would be necessary to re-establish personal responsibility- in the case of healthcare, connecting people with their healthcare decisions and the financial implications of these decisions.
First we would need health insurance reform, which is not only possible in a free market system; it is essential. Allowing individuals to shop for their healthcare insurance over the internet will result in a market driven economy with a concomitant drastic fall in premiums. This will be facilitated by removing the unnecessary state mandates that insurance policies must contain in order to be sold.
If instead, people were allowed to add on provisions that they might need such as a young couple who might need maternity coverage, then a healthcare policy could be customized to suit your needs. Purchasing a health savings account and a high deductible plan compels the patients to assume more control over how healthcare dollars are spent because suddenly, they are connected to the financial implications of the healthcare decisions that they make.
When patients demonstrate healthy behaviors, such as weight management and exercise, then health insurance premiums go down. Patients who are smokers or who are obese, will pay higher premiums. What if you could purchase your own insurance policy and get the same tax benefit as does your employer? This would free you from undesirable employment without losing your health insurance.
And what if you could keep your policy for a term of 10 or 20 years, like life insurance, without a premium rate change? When you are young, the rate would be low, but would rise with age. Health insurance reform at the state level could make these ideas a reality. Provisions could be instituted preventing insurance companies from rejecting patients who were poorer risks. States would be given the opportunity to develop high risk pools that were affordable and would “kick in” after certain out of pocket limits were achieved.
Patients who are now better consumers will demand more transparency in healthcare pricing and they should get this. Doctors and hospitals should be required to post their fees and allow patients to decide where and how they wish to spend their healthcare dollars. Removing fee schedules that are set arbitrarily by third parties and allowing the marketplace to adjust them will result in a dramatic downward shift of the healthcare cost curve, and will improve access to care.
A large reason for the high cost of medical care is attributable to defensive medicine. This accounts for as much as $600 Billion annually according to a survey by Jackson Healthcare. One way to cut the waste in our medical system would be to reward states that enact meaningful medical liability reform. There are proposals that have been introduced such as the one slated to be introduced in Florida in the next legislature, which would remove medical liability from civil courts and put these cases into a specialty court. This system is based on a variation of workman’s compensation and no fault insurance, and gives patients who would typically be unable to receive compensation for medical injury, fair treatment.
Patients who are currently receiving Medicare should be most concerned about Obamacare, because there is no provision to prevent it from going bankrupt. However, there have been several plans that promise current seniors that they keep their current benefits. Changes that would be made would affect people who are at least 10 years away from receiving these benefits. Since on average an American pays $114,000 over a lifetime into Medicare, but receives $355,000 worth of benefits, one change might be to require wealthier Americans to assume a greater percentage of the costs for this coverage.
One change that could be made immediately is to give seniors vouchers for coverage that they could use to purchase insurance from private insurance companies. There would be fierce competition for this business and seniors would realize tremendous value and increased services. By allowing seniors to use this money in a health savings account, they too can control how dollars are spent and accrue savings which might be used to purchase long term care policies. The same scenario could occur for the Medicaid program, but on a state level, with block grants from the Federal Government. By permitting Medicaid patients to control how healthcare dollars are spent, behavior can be shaped, such as diverting care away from expensive facilities such as emergency rooms and directing it to clinics. Money that is saved by patients in their accounts can be accrued and used in the future.
Healthcare reform does not need to be political or partisan. It doesn’t need to be contentious. It does need to be fair for the majority of people and individuals should be in charge of it and make their own decisions both medically and financially. Federal and state government should not be picking winners and losers. Their job is to level the playing field and get out of the way. That is what we can all hope for.
Hal C. Scherz, MD is the Founder and President of Docs4PatientCare, VP of Georgia Urology, and Associate Clinical Professor Urology- Emory University.