On June 24, President Trump signed an executive order, intended to return health care decision-making back to patients. It requires hospitals to publicly disclose how much patients will actually pay for services that they receive. It also gives patients the ability to use funds in tax preferred accounts such as HSAs (health savings accounts) to shop for health care. Both puts power in the hands of patients by providing information and opportunities previously unavailable to them.
Health care is the only industry where consumers have no idea how much they will pay for services until after they have received them. Powerful special interests, like insurance companies, hospitals and pharmaceutical companies, prefer to keep things as complicated as possible, shielding patients from the true price for medical services. At the executive order signing ceremony, a young woman shared the story about the stage 3 cancer that she successfully battled, but that caused her family tremendous financial hardship. Much of this problem was caused by the inability to shop for medical services. She had difficulty understanding why two bone scans done three weeks apart at two different facilities in the same city should differ in price by 30 percent.
According to the CDC, approximately 30 million Americans lack health insurance, largely because individuals cannot afford the exorbitant health care premiums while having to pay more out of pocket for services in deductibles and copays. A typical American solution to this problem is called Direct Primary Care (DPC). For as little as $40 monthly, a patient can have a regular doctor who will see them as often as needed and provide all services that they have available to them in their office. Many of these doctors provide prescription medications at no additional cost. Additional services that cannot be addressed by the primary care doctor are outsourced to specialists who agree to see these patients at steep discounts in exchange for cash at the point of service. Steep discounts are also negotiated with facilities for X-rays and laboratory studies, often at 90 percent less than at hospital-based facilities.
DPC is a direct threat to insurance companies, pharmaceutical companies and hospitals, all of the special interests which have profited from the current health care dysfunction. All three have mobilized to make it as difficult for this health care delivery model to proliferate, but despite their efforts, it is growing. 26 states have passed legislation to protect this model. There are over 1000 DPC practices across the country and the Trump executive order makes it possible for this number to explode.
Currently, patients must pay for DPC out of their own pocket because they are unable to access their own money in tax preferred accounts like HSAs to pay for it as these funds are linked to insurance. And employers who wish to put away money into a tax preferred accounts like an HRAs (healthcare reimbursement arrangement) are prohibited from doing so. No longer. The executive order clears the path for this to happen.
The result will be increased demand for DPC doctors and a proliferation of DPC practices. Coupled with the short-term insurance plans that were extended, thanks to a prior Trump executive order, a patient now has the full complement of health care coverage opportunities, like a regular doctor for less than a cup of Starbucks every day and a network of services available to them at costs that are actually affordable. By providing these options outside of “traditional” health care insurance, the costs are transparent and affordable for most Americans. And finally, real health care insurance that covers catastrophic or expensive medical events, not the current system which is essentially a prepaid health policy. The current short-term health care plans will be transformed into longer term catastrophic or major medical plans.
This executive order changes the trajectory of health care, taking medical decision making out of the hands of special interests and placing it back with patients where it belongs. Contrast this with some of the rhetoric coming from the Democrats who think that the government should control all health care in the U.S. The Trump executive order is another step designed to put patients first.
There is still much that must be done to repair a health care system that has spiraled out of control, largely because of government involvement in so many areas. The next step will be to create the apparatus that will make it possible to enforce the objectives of the executive order. There must also be further actions taken to get bureaucracy out of health care, which will allow doctors to more easily take care of patients.
The latest Trump health care executive order has not received the attention it deserves, but it is a game changer for patients and for health care.
Dr. Hal Scherz is the Founder and Secretary of the Docs 4 Patient Care Foundation and the President and Managing Partner of Georgia Urology.