Dear Senator: The opportunity to fix our broken system rests at your feet. Do It Right.

Marcy Zwelling, MD, Co-Chair of the National Physicians Council for Healthcare Policy,, shares her urgent letter to the United States Senate.

Dear Senator:

The opportunity to fix our broken healthcare system rests at your feet. You and your republican colleagues should look at this legislative opportunity as your moment in history to step up and do it right.

America’s healthcare delivery system was broken long before the ACA. Returning to a pre-ACA state of affairs should not be your goal. Your efforts should be visionary not reactionary. It’s time you show America’s patients that you are the party of better practical ideas.

Healthcare reform is about designing a system of healthcare delivery that works to maximize access, decrease cost and minimize the regulations that obstruct America’s physicians from doing our job.

Simply, the Senate bill should not increase the marginal tax rates for middle class Americans. It needs to practically cover more not fewer people and should offer an affordable alternative.  Allow states the flexibility to create cost effective working laboratories for better care. Indiana is a great example of innovative thinking allowing for greater patient input into his or her own care by extending the utility of the HSA.

As a matter of fact, this example is one physicians support most vigorously because it is provides the most reliable vigorous opportunity to reduce the cost of care, which is our ultimate goal. A transparent competitive market place is the proven means to contain costs while improving quality. Our council is committed to better patient care by working more directly with our patients without insurance of governmental interference.

We know you are equally committed to a fluid marketplace where educated informed patients can make choices that they own, choices to make for a more productive day.  That is the America we all love and cherish.

It is time to focus on the task and not the 2018 election. This is the time for the Republicans to be the party of solutions rather than allow internal division and unrealistic far right rhetoric to dominate our crusade to demonstrate that you are the party of effective innovative ideas.

Again, focus on providing the means to more affordable insurance for our patients, which allows patients to take their tax credit to the group market where costs are lower. Further, create a marketplace where insurance is portable and personal by allowing all employers (not just small employers) to purchase insurance for their employees and extend the tax credit to all employees.

Expanding the HSA market and getting rid of the individual mandate would also expand the choices available to patients.  Allow healthy people to purchase catastrophic insurance that has real value to them and structure it so that it is easy to use in conjunction with their HSA and protect them financially. This is a winner for the GOP and your consumer-market driven platform that centers philosophically on patients owning their own lives.   Creating a defined contribution plan would limit the cost to the federal government.

It is fact that guaranteed issue increases the cost of insurance to healthy would be purchasers. To reduce the premium cost, encourage states to tax insurance companies who want to sell insurance in that state.  Insurers should be taxed relative to their market share.

The Senate GOP needs to author practical reform legislation. Ironically, you don’t have to look too far.  Dr. Bill Cassidy (Louisiana) has written and presented a bicameral bill with Congressman Pete Sessions (Texas) that brings it home for the GOP. The bottom line- more, not fewer Americans will have an affordable opportunity to get health insurance and find a physician for life.

The GOP needs to make sure that Medicaid dollars are driven toward caring for the disabled, children and pregnant women as it was designed.  The ACA perverted Medicaid by hurting low income states and funneling federal dollars toward non-disabled working class adults without the hoped for results of better health (Oregon Medicaid experiment). The GOP should not solve the problem by throwing more money at Medicaid but should demand states demonstrate the effective use of those dollars. Medicaid should be limited to 1) care for women & children, 2) care for the poor, and 3) long term care with stable funding based on real data, not hyperbole.  This will calm opponents and quell the markets and allow the physicians to get back to patient care.

America’s health care delivery system is on the verge of collapse and the nation’s physicians are experiencing overwhelming burnout and are leaving the profession at an unprecedented rate. It’s time that the GOP get busy and author a practical workable solution that shows the country that they are the party of innovation and focus.

The GOP message must feature the idea that the GOP is the only thing standing between America adapting an expensive, authoritarian, non-democratic single payer system.  The GOP must get on their horse; ride high in the saddle, and save America’s healthcare delivery system.


Marcy Zwelling, MD
Co-Chair, National Physicians Council for Healthcare Policy

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