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Monday, Mar 18, 2024
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VIEWPOINT

By Michael Arnold Glueck

The healthcare wars continue to escalate, and the fight is fueled by a failure to communicate.

There is no prerequisite that the people must choose between the status quo at one end of the scale and the prematurely floated House Resolution 3200 at the other.

Paul Begala, a Democratic strategist close to the White House, recently outlined the current strategy to revamp healthcare: Supporters of reform have to put the status quo on trial.

Instead, let’s advocate fundamental reforms that:

·; Impose no new net burdens on the taxpayer;

· Do not hasten the bankruptcy of federal and state governments;

· Create no new bureaucracies or stakeholders;

· Involve no expansions of government or additional accrual of unconstitutional powers;

· Improve the quality of care by encouraging innovation;

· Allow physicians to concentrate on healing rather than constantly changing administrative rules;

· Restore the patient/physician relationship and the joy of helping others;

· Increase supply, availability and competition, and thus decrease costs and make it easier to serve those who are most in need of help;

· Discourage frivolous or predatory litigation.

Specific desirable legislative changes include the following:

· The freedom of patients and physicians to choose or decline to enter relationships on mutually agreeable terms for medical services must be guaranteed. This amounts to keeping the promises made, and codified into law, when Medicare was enacted. This is also in the spirit of Obama’s promise that people can keep their health plan or their doctor if they want to.

· The determination of insurance reimbursements must be separated from the determination of fees: reimbursement involves insurer and subscriber, and the professional fee involves the patient and the professional (i.e. value-based payment, with patients determining the value).

· Tax discrimination must be ended. Under current federal tax code, all medical services paid for through employer-owned insurance policies are purchased with pre-tax dollars, while individually owned insurance or out-of-pocket payments must be made with after-tax dollars. Eliminating this inequity should decrease both expenditures and actual costs by eliminating over-insurance and thus excess demand for services of marginal benefit. It would encourage direct payment at the time of service, without the administrative overhead that inevitably accompanies third-party payment.

· The McCarran Ferguson exemption that protects the business of insurance from antitrust law should be repealed. Monopolies and cartels increase prices; competition drives prices down. The insurance industry should have to operate under the same rules as other enterprises.

· Barriers to market entry should be removed. These reduce access and increase prices. Anti-competitive barriers include certificate-of-need requirements.

· Americans should be allowed to purchase insurance across state lines. Residents of states such as New York and New Jersey, whose state mandates have made individual policies prohibitively expensive, could buy a policy in Nebraska or another state with a reasonable regulatory regime. Rep. John Shadegg of Arizona has introduced such legislation.

· All Americans, including medical professionals, should be protected against the court-ordered seizure of their property for the private benefit of plaintiffs and their lawyers, beyond reasonable compensation for actual damages. Subjective “pain and suffering” and punitive damages are the equivalent of criminal fines; they should be subject to an appropriate higher standard of proof and should be paid to the state, not the lawyer. Applying the equal protection of the laws to plaintiffs and defendants should decrease predatory or frivolous litigation, and thus decrease excess costs from defensive medicine. This should also stimulate the development of other means of protection against poor medical outcomes including better disability insurance purchased by patients. How can 500,000 practicing physicians pay the insurance for 300 million patients? It is irreconcilable with the entire theory of insurance.

Put simply, we need to espouse a patient-centered system rather than a government-controlled system. These are the right kind of changes from the status quo.

Glueck is a medical doctor in Newport Beach who often writes on legal issues in medicine.

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