A Conversation: Can Free Markets Save American Medicine?

A recent article from the Mises Institute. “Under Socialized Medicine, The State Owns You,” sparked a conversation between Mr. Bob Wells and IP4PI founder Dr. Craig M. Wax.

Bob

I appreciate your assessment of the solutions presented like VA, Medicare and Medicaid being awkward, too expensive, and failing in large demonstrable ways. We haven’t had true market based medicine since World War II. Prior to that, it was relatively inexpensive cash and Barter based services. I argue this is the most efficient as it cuts out insurance, pharmacy benefits managers, all levels of administration, and last but not least, all aspects of government regulation compliance and taxation.

In the last six years there have been at least 12 plans on the table to repeal Obamacare. And, there have been six in the last 12 months. There was no sparsity of plans, just no palpable consensus.

I assert that inexpensive primary care, labs, low-end studies, cheap generic medications, will allow for most needs to be met by most people. And expanded health savings account HSA would be used for each citizen to use pretax dollars to buy anything health related from gym memberships to over the counter medications to actual care necessities. Further, inexpensive catastrophic insurance for the big ticket items would be also affordable by most. There could be community, charity, and state programs to provide for the neediest, while keeping the federal government taxation hands to itself.

Unless the Congress and President act soon to repeal Obamacare, just rearranging the deck chairs, will not prevent its fate. Already 19 out of 23 taxpayer-funded co-ops have gone bankrupt taking billions of taxpayer dollars with it. And for the phony federal mandates state exchanges, many have only one high price insurer participating, while still others have none. Leave it to the government to mandate you buy something very expensive and then there’s no opportunity to even comply!

Best wishes for good health,
Craig M. Wax, DO

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Dr. Wax,

The deficiencies of state-sponsored health care are widely known. What is difficult to figure out is an alternative — market-based — that is universally accessible and affordable (with affordability being as elastic as elastic can be), while still offering high quality. If there is a model in this world, I am unaware of it.

All efforts America has made to provide public support for health care since World War II, from the VA system to Medicare and Medicaid to Obamacare, have been awkward and grossly inefficient (if somewhat effective, overall). Unfortunately, blowing these systems up and starting a new system based solely on market forces would be catastrophic in the short term. And since politicians think in the short term, such a radical transformation is impossible.

Today’s Republicans realize there is reward in trashing Obamacare, but they also know that they do not have a better plan to replace it. If they really had a better plan they would have introduced it by now, and it would be on President Donald Trump’s desk for signature. The fact that they cannot agree among themselves on a replacement is testimony to how difficult a problem this is. (This does not excuse the Democrats, either.  They’d rather let the Republicans look foolish than offer their own “solutions.”)

Regards,

Bob Wells

Real Solutions Encourage Responsibility; Safety Nets Should Not Become a Chronic Need

Dr. Robert Villare responds to the AMA’s continued support for Medicaid Expansion and ACA:

To K B O’Reilly on AMA wire. Better question to ask is why so many Ohioans (700,000) are on Medicaid.

It is well documented that these populations reproduce with abandon and lack a mother and father family presence, are irresponsible and non-compliant, and practice poor health habits. You write nothing about their need to get responsible or the need for Ohio to create jobs to resolve this root cause problem of the need for Medicaid. Safety nets, while appropriate in some cases, should not become a chronic need for residents.

The rant about covering everyone, with no contingent duties and responsibilities is old. You note nothing about how you think this should be paid for–the real dilemma over the last 30 years. Easy to say “cover everyone” but not easy to pay for it without burdening hard-working people that you will mandate the taking of more monies out of their pocket to give to others who feel entitled and may well lack appreciation for the handout.

Solve that problem. Give them jobs to earn at least some of their medical care, and terminate the costly regulations and liability issues facing providers in this litiginous population.

Dear CNBC, Please do your research before you comment…

Dear CNBC, please be advised that before you criticize anything, you should do your research. The unaffordable careless act, known as ACA Obamacare, has changed the entire field of health insurance to few government approved and some Medicaid subsidy plans. More than half the exchange insurance co-ops started with taxpayer dollars are now bankrupt.  Most private insurers have left Obamacare exchanges leaving monopolies or even threaten to leave no insurers present to prevent citizens from being fined by the IRS for not buying nonexistent policies(see stats below). 

ACA Obamacare has trashed the whole industry and taken competition out of the equation, leaving only high prices and poor coverage. Let me know if you need anything further.

Best wishes for good health,

Craig M. Wax, DO

Family Physician

Media host

National Physicians Council on Healthcare Policy member

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Original post:

Trump trips up as he trashes Obamacare

Dan Mangan, CNBC

http://www.cnbc.com/2016/10/25/trump-says-his-workers-having-tremendous-problems-with-obamacare.html

In 6 Charts, the Rising Costs of Obamacare Rates

Leadership: Let patients decide what quality and value means to them

Michael Strickland, MD writes in:

In the face of CMS’ own predictions, Andy Slavitt says “Despite what the table shows, our data shows that physicians in small and solo practices can do just as well as those in practices larger than that.”

I’ll believe that he, and others like him, know what they are talking about when I see them start picking up charts, seeing patients, and relieving their danger and distress, while using the systems they are so eager to mandate. I have medicaid and medicare patients who pay me cash, because they have problems they cannot get solved by their ‘providers’ who are being directed by these people, and I openly invite Andy Slavitt, President Obama, Hillary Clinton, Zeke Emmanuel and anyone else advocating this to visit my office in Cincinnati and show us how it’s done. Continue reading

Ayn Rand’s speech against socialized medicine in 1963; 100% relevance today.

https://ari.aynrand.org/issues/government-and-business/health-care/How-not-to-fight-socialized-medicine

What’s the ICD-10 Code for Struck a Duck?

A physician writes:
A long time patient came in.  He told me he was fishing, his pole started to twitch, he turned around quickly and tripped over a duck, injuring his hip!  Never before, in my 25 years of practice, has a patient presented to me w such a c/o.
CMS lists ICD-10 codes for struck by duck and bitten by duck but I can’t find a *&#! code for struck a duck!
icd-10-duck

 

ICD 10: anticipated and unanticipated consequences of government mandate

ICD 10: anticipated an unanticipated consequences of government mandate

Craig M. Wax DO

October 1, 2015 ICD 10 was mandated by the US federal government department of health and human services (HHS). Their stated goal was to improve data collection and research but the consequences, both anticipated and unanticipated, are becoming clear. 

Even before day one of implementation, it has been costly in time, money, and work that needed to be redone. Laboratories and other testing facilities call constantly for new codes in ICD 10 before they will do testing on patients, even though the codes are for billing, insurance, and government bureaucracy purposes only. Patients are being turned away from labs and radiology facilities. 

Patient history and examination time is now squandered due to electronic health records EHR and chasing new ICD 10 codes. Insurance companies have required “referrals” since about 2000. Originally, referrals meant when a doctor recommends another doctor or facility and gave them an RX script to use that service. Initially, referrals become a paperwork game where a form was filled out for insurance to recognize the service. The insurance companies even said that the referral wasn’t even a guarantee of payment, so what was it for? Since, it has become an electronic online process with an Internet company owned by insurance companies called Navinet. Now, our staffs have to enter all the referring information and diagnosis codes in order for the insurance process to even begin or the patient be scheduled for the test at all. Now with ICD 10, the systems are not recognizing the codes and not allowing these insurance mandated processes that waste our time to even carry to completion so a patient can get the study they need.

Due to all these exogenous process mandates, patient care suffers. Less patient physician contact time is possible in the exam rooms. Physicians, and their staff, are designated data gatherers for insurance and government whims. Time and money are wasted by all parties that are gathering the mandated data. The data will be aggregated by government and pirated, patients extorted, and data lost, with no party responsible except for the physicians who entered it. Patients get frustrated because care is denied due to insurance not reimbursing for procedures due to flawed, complicated processes mandated by the insurance industry. All individual patients’ and physicians’ privacy, security, and care is lost. 

This is yet another government, and their industrial cronies, scheme to command the data and make money for themselves, while patients go without care and physicians suffer the unanticipated consequences. The medical community and its physicians must stop abiding by all the nonsense and get back to patient care with direct primary care; putting the patient first and responsible for their care. 

Best wishes for good health,

Craig M. Wax, DO

Family Physician

Host of Your Health Matters

Rowan Radio 89.7 WGLS FM

http://wgls.rowan.edu/?feed=YOUR_HEALTH_MATTERS

Twitter @drcraigwax