NIS

Suggestions From a Doctor for Fixing Health Care

Let the Health Care Marketplace Fix Itself

  • Remove all impediments to competition
  • Give patients more choices
  • Allow patients to chose their own benefits package including lifetime benefits limits
  • Discourage the Spare No Expense attitude
  • Provide a no frills safety net
  • Relink consumption demand to payment responsibility
  • Ban price gouging in emergency care
  • Stop mandatory screening programs
  • Reduce paperwork/computer work
  • Put the responsibility for quality assurance  and continuous quality improvement back in the hands of physicians
  • Stop duplicate credentialing
  • Put generation of practice guidelines back in the hands of physicians and out of the hands of industry
  • Get industry out of the business of supporting practice guidelines
  • Any willing provider law
  • Let Medicare negotiate drug prices

 

I could write a chapter on each one of these bullet points but for the sake of holding an audience's attention I will just cover the highlights. One of the reasons that the health care market place is in such bad shape is because it is a market completely sheltered from normal marketplace competition and rift with cartels, monopolies and anticompetitive behavior. Also the price structure for services is not aligned with usual and customary as it once was.

In 1965 President Lyndon Johnson signed into law Medicare which overnight became the largest insurer in the country. The first thing that Medicare did was to create a fee schedule at a severely discounted rate over the average usual and customary. This had two consequences. First in incentivized fee gouging. Physicians who were hurt by the Medicare discount increased their fees for other patients. Second, it made millionaires out of eye surgeon and other specialists who were able to crank up their volume.

In the 1970's President Nixon laid the ground work for the creation of HMOs giving them protection from liability for injury to patients caused by their policies.

Pharmaceutical companies have been allowed to form cartels and control prices of drugs through a variety of means. Medicare, our largest insurer, is not allowed to negotiate drug prices. The drug manufacturers claim that they need their high prices to support Research and Development. Every other country in the world negotiates drug prices and pay much less than we do. The consequence of this is that we are supporting R&D for the entire world without getting additional benefit.

In summary if we get government out of the way and allow patients to make better choices for themselves and doctors to serve no one but their patients  maybe all of the damage done by government interference can be corrected.By far the best judge of what is best for the patient is the patient themselves in consultion with his doctor. A third party, Government or beaurocracy created by government does not improve on that.