About a year ago, I submitted a suggestion to improve our health care delivery system and the financing of it. In stead of a market driven system, we have forced upon us a government dictated system which will destroy health insurance companies and limit health care to Americans. As I generate this submission, Congress is debating a bill to repeal Obamacare. The obvious complaint of opponents of repeal is that
Health Care Funding Reform – A Proposal
ObamaCare really does nothing to correct the underlying problems in our health care delivery system. In fact, the new regulations will make problems worse. Most of the current problems are actually the result of government intervention in the system we had before the mandate for “managed care.” It is not really managed care, but managed cost to 3rd party payer. The result is higher cost to consumer.
I would like to begin with a hypothetical. If I sold a card, on an annual contract, for $500 a month that allowed the holder to shop and buy almost anything for a $20 co-pay, it would be heavily used. Next year, I would have to increase the cost of the card. That is where our health care system is, today. It is the Federal Government which caused our current problem when “managed care” was mandated in about 1984.
Save money – increase the efficiency of health care utilization:
1. Have people pay for a percentage of whatever health care they consume, up to a predetermined maximum, when insurance will cover expenses at 100%. Before “managed care”, patients were wise shoppers when purchasing medical tests or treatments. Not now!
Save money – reduce the number of tests:
2. Tort reform is essential. It works fairly well in Texas. Texas caps awards on non-economic damages at $250 thousand. Perhaps, the loser should also bear legal the expenses of the winner. The necessity of practicing “defensive medicine” is expensive and inhibits good medical judgment.
Incentivize purchase of health insurance:
3. Give employees a tax credit for what they spend on health insurance premiums. That way, the employee is revenue neutral and has insurance. Also, the employee owns the policy and is not dependent on an employer. Also, if younger healthy people have an incentive to join the risk pool, insurance companies have no great excuse to increase premiums because they are only insuring sick people. If this were the law, who cares if an illegal alien has insurance. He paid for it.
4. Bar employers from buying health insurance, but give employers a tax deduction for whatever they give employees for the employee to purchase health insurance. The employee needs to own the policy. Portability is achieved.
Make health insurance premiums competitive:
5. Require health insurance carriers to publish an audited report as to what percent of the premium dollars are actually spent on health care. Clinical audits are not health care. Help purchasers see what they get for their money. I am aware of one HSA policy that only spent 9% of the premium income on health care and still demanded a double digit increase in the premium payment the following year.
Make health insurance premiums competitive:
6. Allow sale of health insurance across state lines. That will increase the risk pool for insurance companies, and make it more profitable to lower their premium rates. In return, they must be required to pay a “clean claim” within 30 days, and not hold on to the payment for several months. Penalties for not paying claims in a timely fashion should be significant. In Texas, the insurance company which delays claim payment loses part or its entire “negotiated” discount from billed rate. Physicians should not be forced to provide interest free loans to multi-million dollar companies. Prompt pay works in Texas where a “clean claim” is defined by law. Also, deny insurance companies the ability to wait more than 180 days to demand repayment of what they perceive to be an over payment or in appropriate payment. There is no way for a physician to recover a loss and the insurance companies can surely discover their own mistakes before that time expires.
Assure availability of health insurance coverage:
7. Prohibit denial of coverage on pre-existing conditions and cancellation of a policy for illness. The larger risk pool will help decrease the risk of coverage.
Provide for the few who still cannot afford health insurance premiums:
8. Provide Federal subsidy for free or part pay clinics for the indigent, and those who still do not have health insurance. If someone makes enough money to buy insurance and does not, he/she pays more than someone who still cannot afford the premiums. Provide tax deductions or credits for hospitals, imaging centers and laboratories which donate facilities to provide care for the indigent. We had a system similar to this before “managed care”. Most hospitals were operated by local government, under terms of a bequest with charitable contributions, or faith based organizations. Give the same inducements to pharmaceutical companies to provide medications. They already provide samples of newer medications and have programs for those who cannot afford to pay for prescriptions
Provide for those who still cannot afford health insurance premiums:
9. Give physicians who volunteer time to work in the clinics described in item 8 a tax deduction or tax credit for their services. The amount of the tax break should be the average billed rate for the service in the area being served.
Protect physician-patient relationship:
10. Remove third party intrusion into the physician-patient relationship. Today, when people call to potentially schedule a new patient appointment, they do not ask about training or experience of the physician. They do not ask about cost or fees. They ask, “Is the doctor on my plan?” If they do not have to pay more than a small co-pay, all that matters is the insurance coverage and not value of service rendered. To repeat, patients need to be wise shoppers for health care, like everything else they buy.
Give volume buying power to reduce premium rates for individuals:
11. Allow membership stores like Costco and Sam’s Club to become outlets for health insurers. Insurers should bid for the right to market to club members. The result is expected to be rates for individuals in line with what large corporations currently pay for their employees, and attract more members to the stores.
In closing and summary, instead of using a stick to try to beat the American public into submission, use a carrot as an inducement. Taken as a total package, the above recommendations seem to address the problems existing in our current health care funding. Don’t cripple health care delivery to attempt to accomplish that goal.
The Republican party has no alternative. For those of you who missed the original post, or have forgotten it, I have repeated it. If you agree with the proposals, PLEASE contact your Representative and Senators. Urge them to bring it before the Congress for debate and possible approval.
Dr. Barry Jacobs is a Reproductive Endocrinologist, practicing in Carrollton, Texas, a northern suburb of Dallas. He completed his residency training in obstetrics and gynecology at Baylor College of Medicine in Houston, and remained at that institution to become its first fellow once Baylor achieved accreditation for an advanced training program in Reproductive Endocrinology and Infertility. Dr. Jacobs has served on the faculty of several medical schools and was director of Reproductive Endocrinology at Texas Tech Health Science Center in Amarillo. Currently, in addition to his clinical activities caring for infertile patients and those with recurrent pregnancy loss, he is Chairman of the IVF committee at Baylor Medical Center in Carrollton.