2012-08-31 / Columnists

A Rising Tide

Health Care Solutions: Repeal, Then Deal
Commentary By Dr. Harold Paez

With the Presidential election less than three months away Americans are beginning to focus their attention on the weighty issues to be decided in November.

This time around there are clearly defined, opposing positions and a fork in the road ahead which cannot be ignored. The Supreme Court’s decision allowing President Obama’s health care laws to stand has placed the repeal of this Act on the ballot as surely as we will be deciding on the future course of our economy.

Do we continue along the current route of larger government expenditures towards the establishment of an economy based on a stronger centralized model? A model from which decisions are made with an eye towards social “balancing” and an artificial leveling of the economic playing field? Alternatively, do we double back and proceed in the more no-holds-barred free markets/free enterprise direction for which the only limits are as good as our legal and regulatory mechanisms?

Our country has ample experience in working with the latter alternative, very little history working with the current economic model and similar experiments in nations like Japan and Greece tell us that the idea of a government mandated recovery like the one we are experiencing is no recovery at all. What’s more, the current state of our economy, with rising unemployment rates, anemic GDP growth, decreasing job participation rates and tight regulatory control, is causing a distinct chafing under the collar of the traditional American entrepreneurial spirit. Americans are beginning to realize, under the whiplash effects of an economy which came to a screeching halt in 2008 and has proceeded to hobble along the side of the road with half its wheels in a ditch, that perhaps there is a more common sense approach to running this country.

We are also beginning to realize how difficult the work of our leadership is in reigning in the horsepower of a free market system while balancing societal issues and foreign policy. At this point, unfortunately, fear and ideological intransigence seem to be driving decisions in Washington and those decisions could have detrimental effects for generations to come. President Obama, after all, inherited an economy run on the basis of free enterprise which he had no experience in rather than the Utopian, government engineered state which he seems to envision.

Healthcare, front and center has been the cornerstone of this administration’s policies. During the economic recession that set in following the banking crisis in 2008, a decision was made to dovetail economic policy and social policy through an overhaul of our healthcare system. This was not so surprising as healthcare accounts for about 17 percent of our economy and is a huge factor in our nation’s unpaid liabilities (through Medicare/Medicaid) and the ever rising costs which are associated with them. The problems and surprises arose when the overhaul of the system was decoupled from the reality of healthcare economics in a free market system.

In answer to the questions of what solutions can be linked to a repeal of the Obamacare laws, what follows are just a few workable ideas with a qualifier to keep the few good parts like no exclusions for pre-existing conditions. First, the national discussion must focus on what we are demanding from healthcare along with a realization that in a sustainable economic model there will be limits to the treatments which can be rendered through entitlements. The limits should be determined by a consensus of our healthcare professionals rather than congressional lawmakers. Budget-busting medication regimens should be renegotiated with insurance plans in conjunction with national retailers like Walmart and Target who already have extensive pharmaceutical networks offering medications at $5-$10 per monthly prescription. There are currently 300-400 commonly prescribed medications on these formularies and the savings would be significant if coupled to Medicare part-D (prescription coverage).

Next, the burden of defensive medicine must be lifted by Tort law reform, the fear of being sued cannot be the deciding factor in medical decisions, rather they should be based on professional experience. Despite what the legal establishment says, studies have proven that the cost of defensive medicine is a significant driver of healthcare costs. As I learned from a lawyer specializing in this type of law, this can be accomplished by simply setting the bar higher for legal proceedings to begin, from negligence to reckless endangerment. This is the difference between a doctor getting sued out of practice because a patient happened to have a severe reaction to a medication and one being sued because he prescribed a toxic dose of medication which would be reckless indeed. Another alternative would be a “loser pays” requirement to stop the health care lottery of frivolous malpractice lawsuits.

Next is the idea of using existing healthcare infrastructure to deliver healthcare to those in need. Why are we going through the huge expense of setting up healthcare exchanges and healthcare plans in each state when existing healthcare insurers can be allowed to compete for patients by opening up competition across state lines? Similar to automobile insurance and homeowner’s insurance. Why can’t we set up a national super-fund for the uninsured who can seek treatment at their local hospital clinic (a co-payment collected at each visit) with the hospital submitting bills for treatment through the existing Medicare structure? Call it Medicare Part Z. Surely the cost of insuring those uninsured would come in less than the predicted 2.6 Trillion dollar cost of Obamacare over the next ten years (2012-22)? Essential to this model is the understanding that most individuals in the “uninsured” pool are actually healthy adults in the prime years of their health. Children are already covered under state administered plans, the elderly are covered by Medicare and the indigent are covered by Medicaid. Statistically speaking, most of the people being addressed by the healthcare “crisis” which President Obama ran his entire first term on, are individuals who are in need of a major medical/catastrophic insurance plan not an insurance Gold Card stuffed with pricey entitlements. Again, surely less costly to insure than the 2.6 Trillion dollar projected cost of the current plan turning medicine inside out.

The biggest political fib told during the last four years is that the nation’s health is in “crisis” when most adults between the ages of 20 and 50 are actually healthy. The biggest mistake these past four years has been to believe that only big government can provide the solution. Health savings accounts linked to catastrophic medical plans would go far to insure young healthy individuals who fear they would not be covered in case of major accidental injury. Finally, let’s work on a plan where the actual healthcare providers themselves, the doctors, are treated fairly without being used as pawns and piñatas for the purpose of filling gaps in federal budgets. The astounding cost of becoming a doctor in terms of dollars and years of study cannot become victim to laws drafted without even being read. There is too much at stake in healthcare to marginalize those that deliver it.

By empowering doctors themselves to continue serving the public health needs we will ensure better outcomes just as surely as employee morale has a bearing on the viability of any business enterprise.

I, for one, wouldn’t want to go to the office of a doctor who just got a letter in the mail from the federal government telling him or her to expect a 30 percent pay cut with an increase of 30 million patients to treat over the next few years. Can you imagine the line in the waiting room?

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