Obamacare and Appeasement: An Unholy Alliance

Republican members of Congress introduced healthcare legislation entitled “The Patients’ Choice Act of 2009.” As per one of the sponsors, Senator Burr:

The American health care system needs a complete transformation. The Patients’ Choice Act will finally enable Americans to own their health care instead of being trapped in the current system, which leaves people either uninsured, dependent on their employer, or forced into a government program. With a focus on prevention and wellness and covering those with pre-existing conditions, the Patients’ Choice Act will make health care affordable and accessible to all Americans.

What Senator Burr and other members of Congress fail to recognize is that the healthcare system has been built on a foundation that favors the interests of the pharmaceutical industry, large hospitals, the American Medical Association, and the medical insurance industry. It has never represented the interests of doctors or patients. How could it, when the voice of corporate entities have been front and center in Congress in the form of lobbyists, campaign donations from special interest groups, along with individual conflicts of interest which encourage members of Congress to continue to place their financial interests above the good of the country.

The Democrats and the Republicans are two sides of the same coin. The former want to control the individual by controlling their access to health by creating a government controlled grid that micromanages an individual’s access to care and choice of treatment options. The latter continues to pay lip service to free market initiatives while continually backsliding and refusing to introduce legislation that will provide a real alternative to Obamacare.  Neither party has felt the need to ask the only group that really understands the problems with the healthcare system – the independent practicing physician.

Both parties have done a masterful job of demonizing the physician. The doctor has been the scapegoat for skyrocketing health care costs while giving even more power to the medical industry to those entities that have been the architects of the broken healthcare system that we have today.  In short, the system is a complex network of corporate middlemen who have worked tirelessly figuring out ways to skim profits while simultaneously shifting the costs to patients, rationing their care in the form of pre-certifications, increasing premiums, and outright denials on one hand while decreasing physician reimbursements (in the form of bundling of payments), lowering fees, implementing recovery audits to claw back reimbursements, and outright denials of payment after services have been rendered on the other. The government has exacerbated the problem by putting rules and regulations into place which encourage and reward this behavior, while ensuring that doctors and patients continue to feed a beast that needs increasingly more money in order to perpetuate a system that is based on the management of chronic disease instead of true prevention. It is no wonder that we are spending more money on healthcare and taking more medication, while, as a society, we are getting sicker.

If members of the Republican Party are serious about true healthcare reform, they need to go back to the basics and remove mandates and regulations that do nothing to improve healthcare, but have actually caused the breakdown of our system. Here are some suggestions:

• Reform EMTALA (The Emergency Medical Treatment and Active Labor Act), an unfunded congressional mandate passed in 1986, which required hospital emergency rooms to treat all patients regardless of their ability to pay. The unintended consequence of this bill has led to hospitals treating all patients regardless of their ability to pay and passing along the cost to those who are able to pay.

Instead:  Require that patients who present to the emergency room be triaged and treated for real emergencies only, and not problems that are best treated in an outpatient office or clinic setting such as removal of ear wax.

• Require that pharmacy benefit management companies (PBMs) be separate independent entities from insurance companies.

This will avoid collusion between the pharmaceutical industry and medical insurance companies that routinely manipulate the medication formulary based on profits not effectiveness.

• Restrict unfair trade practices of large retail pharmacy chains that align with insurance companies as the “preferred” pharmacy for their members.

This practice cuts out small independent pharmacies because they cannot compete; and this destroys price control through honest competition.

• Change the way hospitals are paid so that they cannot double dip. i.e., receive government payments to treat indigent patients while charging paying patients higher fees under the guise of “recouping their costs” for treating indigent patients.

Instead: Bundle hospital fees into a single payment based on the patient’s disease, or surgical procedure.

• Change the tax code

Allow physicians to write off delinquent patient bills as bad debt. This would alleviate the need to send the patient to collections and remove healthcare costs as a cause of bankruptcy. It would also encourage medical care that is gratis because physicians could afford to offer it.

• Allow Medicare and Medicaid access to cheaper drugs from other countries.

Allow importation of drugs from Canada to decrease costs to both Medicare/Medicaid patients and the government.

• Enact tort reform

Make patients who bring frivolous lawsuits responsible for paying all court costs.

It is only by completely overhauling the healthcare system to make it a level playing field that we will begin to truly lower the cost of healthcare while improving access, encouraging innovation, and changing our health care system from one that is disease driven to one based on wellness and prevention. It will not happen if we try appeasement as speaker Boehner proposes by keeping parts of Obamacare. Health care will only be what we want it to be in a free market system based on choice and competition.