PRICE: Transforming health care

Provide access and ownership to patients first

By Tom Price | Thursday, July 31, 2008

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Yesterday, we observed the anniversary of one the most consequential pieces of legislation in our nation's history. It was 43 years ago that President Johnson, supported by members of both parties, signed the Social Security Amendments Act of 1965, creating our Medicare program and ensuring health care coverage for all seniors. Today, both parties stand together again, bound by the idea that we require a fundamental health care overhaul to ensure every American has access to quality, affordable care. What is troubling, however, is that many in Washington see Medicare as the blueprint for this reform.

As a physician, it is clear to me that Medicare is incapable of providing quality care for every American and must not be the model for national health-care reform. Its flawed structure increasingly fails our seniors on all counts - responsiveness, innovation, access, cost and quality. We should focus on patient-centered improvements, not broad expansion of a broken system.

Medicare was surely created with the greatest of intentions. In fact, the 1965 Medicare law proudly proclaimed: "Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided." Yet, having personally navigated the federal health-care system for close to 25 years, I can attest that perhaps nothing has had a more negative impact on the "manner in which medical services are provided" than our Medicare system. Inflexible regulations, one-size-fits-all policies and a flawed cost-containment structure serve only to limit quality and access to patient care.

Viewing care in terms of dollars instead of patients, Medicare dictates to beneficiaries which doctors they may see and how frequently. Doctors, in turn, are told which procedures or tests they may - or often may not - provide. These onerous regulations and coverage rules have led to an erosion of the once-sacrosanct doctor-patient relationship. Health-care decisions, some of our most personal, are often made in Washington's concrete edifices rather than doctor's offices.

Since all patients are viewed the same, Medicare coverage is not tailored to individual needs, and costs cannot be contained. When Medicare was created in 1965, the long-term budget estimate for 1990 (the furthest year predicted) was roughly $9 billion. This year, we will spend more than $450 billion on the entire program, more than 12 percent of all federal revenue, with that share of the budget expected to double in the next 15 years.

These surging costs lead only to greater rationing of care, increased restrictions on care and decreased access to doctors. The constant battle between physicians and the government over permissible procedures and reimbursement rates have led many medical institutions, including some the nation's most respected, to limit the number of Medicare patients they are able to treat. A system that discourages access to care for those it proclaims to help is one that is terribly broken.

Quite simply, Medicare fails to put patients first. It is not responsive, accountable, innovative or flexible to the needs of those most intimately affected by health-care decisions - patients. Yet amazingly, many in Washington proclaim all our health-care problems would be resolved if only more Americans were enrolled in Medicare -a tragic misdiagnosis.

There is another way, however, to transform our health-care system to ensure all Americans have access to quality care. First, insurance coverage must truly be owned and controlled by patients. For millions of Americans, it is the government or their employer that makes their health-care decisions. To provide the portability, responsiveness and accountability needed from insurers, plans should be controlled by the patient, regardless of who is paying the bill. This is the only way to ensure Americans have the ability to decide what coverage and care is best for their individual or family needs. The other imperative of reform is to ensure it makes financial sense for all Americans to purchase insurance. When people have the proper incentives for coverage, we can reach the ultimate goal that all Americans have access to health coverage and quality care. This may be readily accomplished through the adoption of tax equity for the purchase of insurance, active pooling mechanisms for increased purchasing power, and focused reform of tax credits and deductions.

Restoring proper incentives and the power of patient ownership and control is the best way to meet the obvious need for an improved health-care system in America. By putting those most intimately affected by health-care decisions - patients - in charge, we can honor the noble intent of President Johnson's signature 43 years ago to provide access to the highest quality health care free from federal obstruction.

Rep. Tom Price, Georgia Republican, practiced orthopedic surgery for more than 20 years before serving in Congress.

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