Friend of IP4PI and medical freedom warrior Jane L Hughes, MD writes in:
We need something that does not increase the cost to everyone! Approximately 50% of Americans don’t spend more than $1,000/yr on actual healthcare, and 89% don’t spend more than $5,000/year. Also, in my opinion, “Make America Healthy Again” is more a slogan for the public health department, not physicians per se. 100% of Americans who make it past 8th grade have had health class. They know obesity, smoking, drugs, sex, teen pregnancy all lead to problems. They persist in bad habits/lifestyles anyway. That is a societal problem that we all care about, and each of us in our own way influences as a physician. However, our primary job is screening, treating when necessary, managing chronic illnesses with our patients, and stressing behavioral changes that can impact future health issues with our patients. OK, on to what I think we need.
1. Repeal 100% of ObamaCare and start over with transparency regarding cost and sources of revenue for safety net on federal level.
2. Basic structure of new system centered around HSA’s coupled with inexpensive catastrophic indemnity policies to prevent bankruptcy and allow access to care, i.e. no more “co-pays”, networks, or need to band together to get “good prices” which will drive price transparency, as individuals pay for their care out of their account.
3. Tax parity. Allow $5,000/yr individual/yr, $20,000/family/yr pre-tax HSA deposit (see stats above) regardless of who makes the HSA deposit-employer, employee, grandma, etc. Allow the unused to be rolled over to the next year. Eventually catastrophic policy could be purchased from HSA.
4. Federal mandate that all insurance companies must offer at least 10% of their products as bare bones catastrophic with no mandate for coverage other than meeting the deductible chosen by the insured and covering what they say they cover. Insurance companies could charge a small fee for setting up and hosting HSA, or banks could do the same with a credit card only good for medical goods and services. This is what we have with “food stamps” now. However, this would be without the ability to convert into cash by sale to another individual.
5. Shift to individually held, non-job specific, portable insurance. Risk pool is all of the individuals with that company, much like auto insurance, that are insured by that company.
6. Federal mandate for price transparency. No person shall be charged more than any other for the identical drug, hospital service, individual office visit (each doctor would set their own fees, but no network discounts), etc. This would eliminate cost shifting, the generic drug kickbacks, middle men negotiation contracts, etc. Imagine a website with manufacturers suggested retail price for every drug on the market.
7. Number six would necessitate Medicare and Medicaid to either elevate what they will pay or allow balance billing. Some entities would accept the payments as they are, where others would balance bill.
8. Safety net would be tax payer funded HSA’s with tax payer funded catastrophic policy. This has been successfully done in “Healthy Indiana” and in Florida where they found that even indigent people when given an HSA became much better stewards of their healthcare dollars. There was a reduction in ER visits as those drained their accounts.
The above recommendations could be covered in a 10 page bill, max! As I have said until I am blue in the face, I do not want a government “comprehensive replacement plan” for 1/6th of the private sector economy. There was a mandate in this last election. The GOP was dragged to a great majority, especially in state legislators, by Trump. He and Pence have promised full repeal. It must happen, or this massive message to the US Congress will be once again ignored. And, it will be the tragedy of the ages, because we have been rescued off the precipice of one more failed nation state. I respect the views of everyone on this list, and especially the tolerance for vigorous debate.