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

—————

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

House GOP’s Affordable Healthcare Act is Not What the Doctor Ordered or Voters Demanded

While IP4PI appreciates the efforts and goals of the Republican Affordable Healthcare act, it is far from the “full repeal” that was promised over the last two election cycles. As independent physicians, we believe that it doesn’t go far enough in repealing the failed ACA, protecting patient choice and permitting the free market to produce excellence, efficiency and economy. We recommend that big money special interests like pharmaceutical industry, hospital industry, health information technology industry and insurance industry not have undue influence in the process as they have for decades but physicians and patients.

1. Full repeal of ACA/Obamacare by reconciliation.

2. True inexpensive high deductible insurance plans competing across state lines for maximum choice, efficiency and economy.

3. Medicaid block granted back to the states where each state can provide flexible solutions for their citizens.

4. Health savings accounts HSA us should be expanded for use for all medical needs so that patients can select any care or items related to health with their own value systems.

5. Primary care and basic specialty care paid directly to physicians by the patients who selected them. Prices to be posted whether per incident or monthly membership model like DPC Direct primary care.

6. Executive, legislative and judicial for branches of government must abide by this law for their own healthcare.

14 Principles for healthcare freedom

Articles critiquing GOP ACA change bill

Achieving Highest Quality Care for American Heroes – VA to Vets Series by Dr. Wax

IP4PI Founder Dr. Craig Wax has published a trilogy of op-eds devoted to American Veterans:

VA to vets: Delay, deny, wait till they die.”
As a physician, I have the privilege of knowing and helping thousands of individuals. One patient in particular stands out as a victim of government’s malignant ineptitude. He is an affable, hardworking 71-year-old male, who is a veteran of the Vietnam War. There was no Veterans Day parade for him but scorn and disdain, given the anti-war sentiment at the time.
Read more: http://www.washingtontimes.com/news/2015/dec/1/craig-m-wax-va-vets-delay-deny-hope-they-die/

More VA delaying, denying, and more vets dying.
This is the second installment of my VA mistreatment and stonewalling veterans series. These experiences were shared by a patient, who is a Vietnam veteran.
Read more: http://m.washingtontimes.com/news/2016/jan/31/craig-m-wax-more-va-delaying-denying-and-waiting-u/

A Veterans Affairs reform that can work.
I have been heartened in recent months to see moves towards exactly this solution, which was previously touted by Dr. Ben Carson. Executive branch officials working on this issue have given strong indications that they see Tricare as the model for veterans healthcare.
Read more: http://www.washingtonexaminer.com/a-veterans-affairs-reform-that-can-work/article/2603066#!

The Latest Repeal, Partial Repeal, and Replace Plans

3/6/2017 update: The first official look at the GOP repeal and replace plan is out.

The Hill has links to the two portions of the legislation in their story here:
http://thehill.com/policy/healthcare/322609-gop-releases-bill-to-repeal-and-replace-obamacare

CLICK HERE for a two-page summary and CLICK HERE to read a section-by-section summary.

Many of the mandates are killed by the bill, for example the individual and employer mandates.  However the pre-existing coverage mandate remains. The taxes are mostly repealed. The infamous “Cadillac Tax” is kicked further down the road until 2025.

Medicaid expansion would be rolled back over several years and a per-enrollee capped allotment will be paid to states.

Subsidies are rearranged to be mostly age-based instead of income based and will be in the form of refundable tax credits.

Michael Hurd, PhD has a review of the plan: Obamacare Repeal: A Good Thing, But Still Not a Free Market https://drhurd.com/2017/03/06/63226/

2/27/2017 update: The alleged GOP repeal and replace plan under consideration has been leaked.  Highlights/Lowlights: it would repeal various mandates including the individual mandate; states would receive a capped per-enrollee federal contribution for Medicaid; current ACA income-based tax credits would transition to credits allocated by age of enrollee; and tax breaks would be limited for high-dollar employer-based coverage.

For more details and a link to the draft bill see: http://www.politico.com/story/2017/02/house-republicans-obamacare-repeal-package-235343

There are a few notable newcomers since our previous post on replacement plans:

  1. Ted Cruz has introduced a full repeal bill:S. 106, a bill to repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 in its entirety was introduced by Sen. Ted Cruz (R-TX) and referred to the Senate Finance Committee.”
  2. S. 222 the ObamaCare Replacement Act by Dr. Rand Paul which repeals parts of ACA and replaces with more flexible HSAs (no HDHP requirement) and $5000 tax credits to fund the HSA. Read more at Reason.com: http://reason.com/blog/2017/01/25/sen-rand-paul-introduces-replacement-for
  3. Rep. Darrell Issa’s “Access to Insurance for All American’s Act” would offer federal employee health plans to all Americans  http://www.nbcsandiego.com/news/local/Congressman-Darrell-Issa-Proposes-Plan-to-Replace-Affordable-Care-Act-412059253.html.
  4. Cassidy/Collins contains portions of Cassidy/Sessions and would be a partial repeal tied to provisions that allow states to keep ObamaCare on a state by state basis or fund state-based market-oriented reforms: https://www.collins.senate.gov/newsroom/cassidy-collins-introduce-comprehensive-obamacare-replacement-plan
  5. AEI’s “Improving Health and Healthcare Plan” utilizes tax credits and expands HSAs to some extent. It also has an “auto enroll” feature that places non-enrollees in an HDHP.  http://www.forbes.com/sites/theapothecary/2016/12/30/how-aeis-improving-health-and-health-care-plan-would-repeal-and-replace-obamacare/#68d118953be6

And, of course, President Trump has started the ball rolling with his Executive Order on ObamaCare: http://www.cnn.com/2017/01/20/politics/trump-obamacare-executive-order/

Previously announced plans:

Congressman Tom Price’s plan

http://www.washingtonexaminer.com/prices-obamacare-replacement-would-shift-power-to-patients-which-is-why-special-interests-will-hate-it/article/2609165?custom_click=rss

Speaker Paul Ryan: A better way

http://abetterway.speaker.gov/

Congressman Sessions/Cassidy plan

http://www.goodmaninstitute.org/topics/health-reform-bill/

(Former Congressman) Dr. Paul Broun plan (needs new sponsor)

http://www.paulbroun.com/issues/health-care

Brat/Flake “HSA Expansion Act” would eliminate the “mandate” that HSA holders purchase a government-designed high-deductible health plan. “As a replacement for ObamaCare, Large HSAs would encourage innovative products like pre-existing conditions insurance that make coverage more affordable and secure.”

http://www.forbes.com/sites/michaelcannon/2016/06/02/five-things-you-need-to-know-about-the-bicameral-legislation-creating-large-hsas

The 2015 Burr, Hatch, Upton Patient Care Act could make a return:

http://www.forbes.com/sites/theapothecary/2016/12/28/how-the-patient-care-act-would-repeal-and-replace-obamacare/#7152a38a1805

Ideals and principles

National physicians’ coalition for freedom in medicine 2015

https://drive.google.com/file/d/0B6mnHrSAs12lUHhzS0ctMHFVRG1pMXZhZFVkbnFwWDVhNzNV/view

D4PC Rx for Healthcare Reform https://d4pcfoundation.org/about-us/the-physicians-prescription-for-health-care-reform/

Principles for individual citizen healthcare freedom

Featured

IP4PI Physicians support the following resolutions for the legislative, executive and judicial branches of the US:

1.  The full repeal, nullification or reconciliation of ACA/Obamacare as it was:

A. Not passed by majority but buy a partisan Congress by reconciliation. B. Changed by the executive branch 43 times without appropriate congressional action. C. Changed by SCOTUS to be a tax bill. D. Tax bills must originate in the House and ACA originated in the Senate. E. ACA has changed healthcare from a professional physician-patient interaction into merely an act of government HHS/CMS unelected bureaucratic compliance. F. ACA lead to an uncontrolled rise in costs for all citizens through increased taxes, insurance costs, hospital costs, physician costs, use of narrow networks and severely limited ACA approved options. G. IRS and tax penalties for any American citizens violate the US Constitution. H. Mutually accepted individual customer-vendor purchases are the ideal way to allow personal choice, encourage excellence and establish price completion for best citizen consumer value. Continue reading

True Patient Centered Reform: Revisiting Dr. Paul Broun’s Patient OPTION Act

According to our friends at Freedom Works:

“Section 1 of his bold, principled plan repeals ObamaCare in its entirety. That alone would make it worth supporting, but he goes much farther. Inspired by the vision of a truly patient-centered system, his bill addresses the spiraling cost of health care and lack of consumer control in a number of commonsense ways.”

The OPTION Act eliminates the requirement that HSAs be attached to high-deductible health plans, allowing all Americans to save money for a rainy day tax-free. Continue reading

The only way to truly “save medicine” in America

Jef Fernley, DO shares his letter to his Congressman and physician-colleague, Representative Andy Harris, MD.

Hey Andy!

I’m not a huge fan of the frequently Left leaning Medical Economics, (though I am a huge proponent of the Austrian school of economics, as I’ve undoubtedly made clear in the past.)

Their article merely reminded me that I’d been meaning to reach out to you. With a new administration and Republican domination in DC, there is undoubtedly an enormous line already formed for requests of the new hierarchy.

I will add only this, for now. The State/Government does ONE thing when it interferes/regulates/manages/governs free markets, it distorts the signals to both entrepreneurs and customers. We don’t need to “replace” Obamacare with anything. We don’t need to sift through the ACA for the “best parts” to save. The only way to truly “save medicine” in America is to REMOVE the hand of Government COMPLETELY. Continue reading