Government Meddling In Health Care Has Only Made Us Sicker
Distorted medical payment incentives and onerous regulation — conceived by government through Medicare, imitated by insurers, driven into hospitals, and exacerbated by ObamaCare — encourage, and even pay us, to be unwell.
Government trespass into health care, including ObamaCare, has not improved access or lowered costs. Decreasing cost increases access. The only effective way to lower costs is to achieve and maintain long-term population health. Quality care costs less. Competition in the public view will accelerate quality.
Fifty years of government meddling in health care has codified and institutionalized poor population health and health care poverty. It has propped up a $3 trillion industry that perversely rewards peoples' poor health decisions as well as inefficient providers by repeatedly paying for more of the same.
It is an immoral government that expands its power by creating and then enabling an illness-entitled population and A health care bureaucracy dependent on maintaining sickness.
Entitlement in health care is most destructive among cultural opiates. Ceding personal sovereignty for one's health, especially to a remote, nameless, faceless, disinterested bureaucrat, is terminally destructive to the human spirit and leads people to become and remain sick.
Medicaid, into which ObamaCare will push tens of millions more people, ignores all manner of behavior for ill health and inefficiency, pays almost nothing for routine medical care and then completely protects the recipients from the costs of preventable catastrophe.
For instance, diabetes is ignored until the dead foot needs amputation and the leg bypass surgery. The complete first dollar coverage as in Medicaid deprives patients of a crucial short-term-feedback-loop incentive to behave healthfully. Hospitals are adequately paid cost plus to rescue recurring Medicaid tragedies with no interest in wellness.
Some 8 million people are on Medicare via their Social Security Disability. All too often the disability is a treatable condition, which, in addition to branding them incurable, pays that person to remain sick.
A recent example: a 450-pound, 45-year-old patient who angrily fired me for repeatedly urging him to control his diabetes and become healthy, stating that he would lose his income if he improved his health.
Giant national insurance companies lever to become entitled to regulation that prevents competition and deprives customers. Their main interest is acquiring ever more transaction fees without regard for health.
ObamaCare's tens of thousands of pages of regulation prevents competition for insurance oligopolies and hospital cartels, entrenching their waste and inefficiency long term.
Government also prohibits insurance benefit design from motivating patients to comply with medical advice; doing the opposite would improve health. Fischer and Whenberg at Dartmouth have sound evidence that adverse behavior is responsible for 50% of health care costs in America. Achieving health will break the cost curve and decrease the need for government health care and its control of our lives.
Alas, government should exit the business of health care so we can become well again.
Instead of fixing government morass with more government, we need to look anew at health care delivery and financing. The transformation to incentivize wellness requires more competition and less government.
Population health improves when we return control and consequence of health decisions to the citizen and their trusted physician, in a win-win partnership with a local "health risk transfer pool" (HRTP) of their choosing.
My 30-year pursuit of high-quality, low-cost health care for my patients has led to market-tested, measurable solutions with extraordinary patient and professional satisfaction.
We take excellent care of our patients whose illness burden is 10% to 25% greater than average for a cost of 50%-75% less than average.
In our Medicare Advantage plan (to phase out under ObamaCare), we are the doctors and, in effect, the health insurance company or HRTP for our patient population.
The patient and doctor are central stakeholders in long-term patient health by controlling care and cost. Our clinician teams are paid to keep our population well, one person at a time.
In the plan, care necessary for health is affordable and (if allowed by law) has short-term monetary incentives to become and remain healthy.
We invest time and money in long-term health. We aggressively encourage personal responsibility for the clinical and cost consequences of health decisions. We demand patients quit smoking before home oxygen use or before chemotherapy. We have uncontrolled diabetics visit every other week and weigh in weekly.
Our success aligns with keeping members happy, healthy and active; we are candid about medical conditions, risk-benefit analysis and costs of care. We can afford high-risk/cost patient care because preserving wellness saves money for catastrophic care. Catastrophes are few because we monitor continuously and intervene early. Financially incentivizing health works, lowering costs and improving access.
The innovators among clinicians, insurers and providers are impatiently poised, waiting for a market within which to transform health care to benefiting from health. Repeal of ObamaCare and anti-competitive federal (Stark-law) and state (Certificate of Need) regulation will liberate these pioneers to preserve what is still the finest medical system in the world.
Successful "population health" programs exist in pockets around the country.
They reduce first-dollar coverage and adjust co-payments to incentivize shared commitment to health; they add incentives such as premium discounts for a healthy weight or not smoking. We need more of them.
Medical information technology was enthusiastically hurtling forward in disruptive innovation until government began bribing doctors and hospitals onto old-tech, server-based, "automate mediocrity" electronic medical records.
Info tech is just becoming good enough for health care and is primed to jump-start the transformation to population health administered by local HRTPs if only it were released from regulatory restraint. A market will stimulate public reporting of price, quality and service data allowing consumers to shop for value.
We advertise our superior satisfaction and diabetes control data. Others will have to compete.
Technology which tracks blood pressure, weight loss and diabetes testing at home can decrease office visits and alert clinicians to intervene early. Population management software helps focus the care team on people and conditions in greatest need.
State legislatures are eager for proposals to save money while preserving health.
They will like local HRTPs, wherein small local groups, like self-insured employers or association of churches, pledge to behave healthfully, prudently use health care resources and rely on each other in "the pool" for unavoidable high-cost care.
Individual ownership of portable, tax-deductible policies coupled with an HSA and guaranteed renewability would be a game changer.
All of these ideas powerfully return responsibility and accountability for health and prudent use of care to the consumer.
We can liberate these industry innovators to create and invent by eliminating anti-competitive laws and regulations, freeing physicians to associate — as other professionals can — for common business interests, and ending the prohibition on physician-owned hospitals to compete with hospital cartels on quality and cost.
We can relax overnight-stay regulations so surgeries like total joint replacement on low-risk patients can be performed in short-stay, low-infection outpatient centers instead of hospital operating suites shared with septic cases.
We need to abolish the federal antitrust exemptions for health insurance companies and state-based patently corrupt Certificate of Need Committees, both of which stifle competition to keep costs high.
States should enforce antitrust laws against hospitals with local monopolies and with no incentive toward long-term health; they depend on sickness which would be fine if they were lean, efficient, high-quality and attracting medical tourism, but far too many are not.
An innovation to care for the high-risk/cost uninsurable would be to form Statewide Collaborative Internal Reinsurance Pools (SCIRP) supported by a fee from premium payers and HRTPs. HRTPs enrolling the high risk would get premium support from the SCIRP.
Some of the provider-based HRTPs like mine will compete for these high-cost, high-revenue patients; our method of practice can take great care of them at less-than-average cost.
The model is simple: If we lower health care costs by encouraging and maintaining population health, we will increase access, quality and innovation in health care without massive government involvement.
Instead of paying patients and providers to perpetuate sickness, let's unleash bold solutions to improve the health of the American population. |
