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FISHER AND GROSS: Prudence of a patient-centered approach
Allowing patients to choose level of care would result in savings
Everyone wants affordable, high-quality health care. The Affordable Care Act (ACA), also known as Obamacare, is proving to be a less-than-viable approach to accomplishing that goal. Physicians, politicians and patients are beginning to realize that the ACA neglects to address problems with cost, quality and access.
Obamacare fundamentally changes the doctor-patient relationship. For patients, it neglects individuality and forces a Washington-based, administratively imposed, one-size-fits-all expensive approach to the practice of medicine. It expands the failed government policies that have plagued Medicare and Medicaid for decades.
The government’s own actuaries predict that future health care costs will exceed 20 percent of gross domestic product, greater than our present economy-choking 18 percent. Additionally, the projected 10-year cost of the law already has increased from $800 billion to an astonishing $1.76 trillion.
Although intended to provide universal coverage, Obamacare still leaves approximately 20 million people uninsured. Sixteen million people are to be covered by expanding Medicaid, a failed system that does not provide adequate care. Just 30 percent of physicians currently see Medicaid patients because the reimbursement they receive for those patients doesn’t even cover their overhead.
Practicing physicians know there is a better way, a patient-centered approach.
A simple way to restore responsibility to health care spending is to put people in charge of how they spend their own health care dollars. All Americans should have individual health savings accounts (HSAs) coupled with high-deductible health plans (HDHP) for unexpected catastrophic conditions. HSA funds could grow, accumulating tax-free over a lifetime, thereby eliminating the need for succeeding generations to subsidize holders’ care.
For the approximately 17 percent of our population who are truly indigent, their HSAs and HDHPs would be funded from Treasury assets. For the 30 percent of families receiving the earned-income tax credit, those funds would be deposited into their HSAs. For the remainder of Americans, HSA contributions would have tax incentives.
Employers, instead of providing traditional health insurance, could provide funding for HDHPs, which, because of their lower cost, would increase employees’ take-home income. Individuals and businesses would use pretax dollars for purchasing all health insurances.
Historically, the model of HDHPs was criticized because it was thought many people would avoid getting preventive and chronic-disease care because of possible large expenditures out of pocket or from their HSAs. That was a legitimate concern before direct primary care programs, which today remove the obstacles to patients seeking preventive care and management of chronic conditions. Routine expenses should not be the responsibility of an insurance company, anyway.
Homeowner’s insurance doesn’t pay for weeds in your lawn, nor should health insurance pay for your cold or sprained ankle. In a direct primary care model, patients meet most of their basic health care needs for less than the cost of their cellphone bills. HDHP is then restored as true catastrophic insurance. This enables health care decisions to remain between the patient and doctor.
Free-market principles do work in medicine. Lasik surgery is not covered by third parties, yet over time, the cost of the procedure has decreased markedly while quality has increased significantly. Patients have to determine value, and surgeons must compete on price and quality.
HSAs, along with direct primary care plans and high-deductible catastrophic insurance, can provide outstanding individualized care for all Americans. This could enable each generation to fund its own care while decreasing our national health care costs and greatly improving our economy.
When compared to the government-centered approach, patient-focused solutions win every time.
Dr. Kenneth A. Fisher, a nephrologist, and Dr. Lee S. Gross, a family physician and co-founder of Epiphany Health, are the presidents of the Michigan and Florida chapters of Docs4PatientCare.
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