A cool thing I learned from my brother is how to snare a lizard and make him walk on a leash.  It’s simple.  Make a small leash with a slip-knot–a long piece of grass works well.  Put it in front of the lizard.  He walks right into it, because moving backward is unnatural to him. Voilá!  A lizard controlled on a leash, for the amusement of all.

The biggest misconception about The Affordable Care Act (ACA) is that it was crafted by people who cared about healthcare. Like a prom dress on a drag queen, the ACA hides what is really underneath…MONEY.   The ACA was a cunning way for government to take a bigger piece of America’s income, by promising to fix our healthcare system.  Never mind, that many reasons costs are so high, are the direct result of government meddling.  Despite the dubious ethics of FDA drug approvals, regulations governing what insurance we can purchase, mandates forcing employers to promote HMO’s, OR the creative accounting required by doctors and hospitals to cover the cost of treating those who are already on the pathetically underfunded government healthcare known as Medicaid, we trust them to make halthcare more affordable.

Conservative wonky-chick Ann Coulter said it this way, ” As usual, the solution to a problem created by government intervention, is more government intervention.  This is like trying to sober up by having another drink.”

We are to believe the same government that has rarely been able to do anything in an expedient and cost-efficient way, can now make healthcare more efficient and affordable. We are to believe a plan which provides for 16,000 more IRS agents, but not a single doctor, will be more patient-friendly.  We are supposed to believe even though two of the people closest to the President, Michelle Obama and Valerie Jarrett, were previously implicated in “patient dumping” schemes, their motives are pure.

I used to think fixing healthcare should be simple. Now, I know, we don’t need a “fix”, we need an overhaul, but the The ACA revamp, replaces high-medical bills with higher costs for coverage, in return for which, patients will get less care.  Patient choice will be limited and replaced by government regulation.  Doctors’ treatments will be determined by formulaic federal guidelines.

My skeptical critics, say I am a pessimistic, a cynic, or a doomsayer, because their healthcare has already improved.  Call me Eeyore, but the issue is not what your healthcare looks like today, the issue is what it you can look forward to in the future.  The Affordable Care Act is not yet fully defined or implemented.  It’s conditions and provisions are still being written.  The law won’t even be fully implemented until at LEAST midway through the next presidency–and provisions in the bill allow for it to be revamped as needed, should costs be too high.  The ACA is akin to signing a contract, without knowing the terms, or playing a game, where the opponent changes the rules, whenever you gain an advantage.

Healthcare is a business, and should be allowed to function like our other favorite businesses–systems in which consumers have more power than the government, systems which reward excellence, and prices reflect the value of services.

Consider two computers, both smaller than a package of cigarettes…the pacemaker and the iPhone. There are about three million people worldwide with pacemakers in their chests, and almost as many with iPhones on their persons.

The pacemaker has become a commonly used medical device since it’s introduction in the 1960′s.  Pacemakers vary in their sophistication, but even the most sophisticated perform only about a half-dozen functions.

Since it’s introduction, almost 250 million iPhones  have been sold.  It has at least as many apps.  It can perform millions of useful functions. With camera, video, internet, and satellite capabilities, this pocket-size Eagle Scout–offers everything from amusement to the apps which have the potential to save lives.  No government programs were needed to develop the industry’s most popular phone, and despite the high price tag, consumers didn’t wait for government subsidies to purchase it.

The iPhone has been on the market for less than a decade, yet it has continually become more advanced and more popular.  The latest generation costs close to a thousand dollars, yet people lined up to buy them, when they debuted recently.

The Pacemaker has been on the market for about 50 years, in that time it has improved, but compared to an iPhone, it is still a simple device.  There have been more pacemakers sold, than iPhones, yet pacemakers prices  range from $5000 to $20,000.  If Steve Jobs had been in the business of making pacemakers, I’m betting they’d be smaller–not to mention cooler, less prone to recall, and they’d sell for hundreds, instead of thousands.  The world didn’t know they’d want smart phones, until Steve Jobs, showed us the possibilities.  That’s what happens, when visionaries are motivated by profit.

The few bits of healthcare that reflect a free-market, such as doctor’s salaries and insurance profits have been demonized and blamed for the our rising costs, but they are not the culprits.  Competition for profits, is the reason businesses continually seek to offer more choices of products, quality and price.

In theory, our healthcare system is a free-market system, but it has not been allowed to function as one.  Our healthcare choices have been narrowed down by our employers, whose options are limited because of government regulations.  If the money spent on insurance were put back into the wallets of consumers, things would begin to change in our favor–as consumers would be able to decide which coverage would offer them the greatest value.

Because healthcare is not allowed to operate like other businesses, we often pay for things we don’t get.  If the insurance and healthcare industries were allowed to compete fairly, consumers would drive supply and demand.  For this reason, I favor the solution crafted by a coalition of physicians representing American Doctors 4 Truth.  These physicians are committed to the noble practice of patient-centered medicine and advocate healthcare reform which puts patients’ interests ahead of the government’s.  I have made minor edits to their recommendations below (for readability), and added my own comments in italics, but you can see the full text at the site linked above.

TEMPLATE for TRUE REFORM by Ori Hampel, M.D.,Kristin Story Held, M.D.
Jane Lindell Hughes, M.D., FACS

1. Get employers out of the health insurance business. Patients would no longer be delivered in groups to insurance companies that offer low bids to the employer. The insurance industry would respond with a robust offering of individual policies that would pool risk and compete by virtue of the value of their product, not contracts with third parties.  Our third-party payer system has taken away consumer choice and control.  We have given our purchasing power over to our agents in Human Resources.

2. Allow health insurance purchase as a pre-tax individual expense.  If our government is committed to giving citizens better healthcare, they should allow full tax-deductions for health-care expenses–including the purchase of insurance.

3. Medicaid would emerge as the only Federal government healthcare program for the truly indigent or disabled of all ages, and as stop-gap insurance for those between jobs who could not afford to continue their insurance, much like unemployment.  Riders for pre-existing disease could be added to conventional insurance for a specified time period. States should receive block grant Medicaid funds to decentralize cost and promote innovation. State governors overwhelmingly support being allowed the authority to manage their individual state’s healthcare needs, based on local (not national) demographics and needs.

4. Encourage states to eliminate insurance coverage mandates for non-essential non-medical coverage to lower costs. This would allow affordable catastrophic coverage. Individuals could then menu price additional coverage as needed or desired. Pre-existing condition “riders” could be on that menu.  Federal mandates, make insurance costs higher by requiring coverage of everything from treatment of erectile dysfunction for incarcerated sex offenders, to marital counseling.  Whether or not you need those services, you subsidize them.

5. The notion that insurance is a pre-payment for routine health and preventative care must be replaced with a major medical shared risk model where insurance is for unanticipated medical and surgical expenses after a certain deductible is met. Routine care would not be covered but would contribute to the deductible. Encourage pre-tax funded health savings accounts for discretionary healthcare to encourage.  Just as your home insurance doesn’t cover the cost of light bulbs, clogged toilets or appliance failures, it is necessary for consumers to take more responsibility for routine healthcare costs, like sports physicals and non-urgent care.  This would give medical professionals incentives to create high efficiency low-cost clinics to treat common injuries and ailments.

6. Allow purchase and portability across state lines to increase competition and innovation. Currently, our system limits choices, because of these cross-state restrictions.  The more choices consumers are given, the more insurers will be forced to compete for customers.  Choices would begin to increase, in response to demand from consumers for more choices over both coverage and costs.

7. Encourage states to kick off reform with healthcare summits in which healthcare industry representatives elucidate what their sector problems are, offer possible solutions, and elucidate what each part of the system can contribute to decrease cost, promote transparency in pricing, and promote personal responsibility within the framework of the traditional doctor and patient centered system. Reform must come on the state level.  (See number three above) Healthcare needs in less healthy states, like Mississippi and Louisiana, are different from those of states like Vermont and New Hampshire.  Allowing individual states to tailor their systems to the health needs of their residents, is a more efficient way to manage healthcare spending, than the government’s one-size-fits-all approach.

8. Allow 65-year and older individuals to opt out of Medicare in return for a stipend check. This will only work  with a reformed system as described here.  Senior citizens could then select a private healthcare policy like the rest of the population. Set a time frame for Medicare phase out and retain Medicaid for the indigent of all ages.  The choices given to seniors regarding Medicare–to purchase private insurance, are why Medicare functions better than the meager under-funded government care provided for by Medicaid.  Allow consumers to choose for themselves, the coverage that is best suited to their health situations, as is currently done with the private provisions of Medicare Part A, Part B and Part C.

9. Each physician should develop one fee schedule for all of his or her patients regardless of their insurance. This could be available through a state portal so patients could compare. Cost shifting and horrendous administrative costs would be eliminated as contracts between physicians and insurance companies would be naturally phased out. Until Medicare is redesigned, allow balance billing to the Medicare patient to maintain their choice in physicians and access to care. Physicians could provide gratis care at their discretion.  It every American knows the REAL costs of their treatment and is allowed to make decisions based on REAL costs, the business of healthcare would quickly begin to function like Target, Best Buy and Nordstrom’s–competing for our money and doing their best to become the best in their market.

10. Apply the same transparent public fee list requirements to hospitals, laboratories, pharmaceuticals, and medical device companies. This would again eliminate cost-shifting, burdensome administrative requirements, and would allow physicians and patients to make informed choices. With so much of OUR money being spent on medical care, shouldn’t we know what things actually cost?

11. Enact tort reform to reduce the estimated 30% healthcare and drug costs related to fear of bogus litigation. Texas is a model state where tort reform has reduced costs and allowed scarce specialties back into areas that drove them away with rampant litigation.  Watch late night TV, and you’ll see countless lawyers, trolling for anyone who MAY [or may not] have been harmed.  Legal redress for medical mishaps is necessary, but it is wrong to allow lawsuits to bankrupt entities that may have done nothing wrong.  Companies that have pioneered valuable drugs, treatments or products, are often wrongly victimized.

12. Allow the cost of charitable healthcare to be a tax deductible item by the physician, with a defined limit each year. Consider a registry of physicians willing to provide charitable care.  If the government is sincere in it’s commitment to caring for the poor, they should enable and reward physicians who choose to care for them.

In trying to understand the trouble in our healthcare system, I listened to what others said, and read what they wrote.  I talked to doctors who favored The ACA, and doctors who opposed it. I read books and opinions from liberals and conservatives.  I read industry newsletters and cost projections.  I tried to get a feel for where RomneyCare and other state reforms have succeeded and/or failed.  I am convinced the same free-market that produced the iPhone (and so many other things we love to love) is the best vehicle to make healthcare more affordable and patient-friendly.  Still, a skeptical journalist friend asks me, “Can’t can’t we just try ObamaCare, and see how it works?”

Yes, as long as we understand it is unnatural for government to back away from money.

RECOMMENDED READS:
http://online.wsj.com/article/SB10001424052970203706604574374463280098676.html

http://kellyvictorymd.blogspot.com/2012/10/election-2012-as-healthcare-goes-so.html

http://www.american.com/archive/2012/september/curing-the-pre-existing-conditions-of-obamacare

http://www.redstate.com/lineholder/2012/06/14/is-obamacare-pushing-private-practice-doctors-over-the-cliff-83-surveyed-say-they-are-thinking-of-quitting/

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