If Obamacare Dies, What's Next for Health Care?
The Supreme Court declaring Obamacare dead will not necessarily help Governor Romney and the Republicans -- the death of one monarch may lead to another monarch. We need the proper bill to replace it.
When I was a health care advisor for the John McCain campaign -- and an ardent, vocal opponent of Obamacare -- I wrote of many possible solutions to alleviate our health care dilemma. It is time to reiterate them, with some adjustments. My basic mantra for health care reform: Keep it simple, stupid. Listen up, Governor Romney:
1. Abolish all state mandates. State mandates contribute to billions in additional costs to the basic insurance premiums. Let the market dictate what is covered.
2. Allow health insurance coverage to cross state lines.
3. Allow affinity groups to offer insurance to their members. This would allow churches, synagogues, AAA, AARP, and even Costco to offer health care insurance to their members. The sheer numbers from membership will bring competition from the different carriers to provide the most coverage for the least cost. Some of these groups may even offer lifetime memberships, which in turn would afford the member similar health coverage regardless of job insurance.
4. Allow catastrophic or major illness insurance. By removing forced state mandates, you will allow very reasonable catastrophic insurance policies. A 20-year-old healthy person should not be forced to pay for colon cancer screening.
5. Allow physicians to be just that. If a physician -- notice I did not call him or her a health care provider -- is a "provider" for a particular health insurance plan, then whatever he or she orders must be accepted by that plan. The insurance company can economically credential these physicians every two years. They can even remove them if they feel they are too "generous." The patient should not be used as a pawn.
The above five constitute the “easy” solutions. Now come the hard ones.
6. We must remove the Vegas-style gambling on medical law suits. You've seen the commercials: "Have you ever had a headache? You may be entitled to compensation.” I've proposed several solutions over the past few years, but have come to the conclusion that the simplicity of the English system -- the "loser pays” system -- would be best for America. No one is prevented from suing, but there would be no free roll of the dice. There must be money on the table to force accountability. There is always risk in life: if you sue and lose, you pay the cost.
7. Allow re-importation of drugs. It is simple and it is safe. Did I mention simple?
8. This one is a stretch, but I love it. Make medical school free, and shorten the four years of college, four years of medical school to six total years. Make all state schools free or nearly so. In return, the young doctor will give back to his state two to three years of service: two years if served after basic training (general practice), or three years after specialty training. This will encourage generalists. Private schools will still run the same, but will be at the cost of the student.
When confronted with a complex medical condition, we as physicians are trained to find as simple a solution as possible by breaking down the components and solving the critical problems first, and then worrying about the minor ailments. While these eight steps may not "cure" what ails all of health care, they will allow the freedom of choice that Americans are entitled to. There is no one-size-fits-all answer.
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