A Doctor’s ​7​ Point Plan for Affordable Health Care in America

Alex Wong/Getty Images
Alex Wong/Getty Images

Sir Winston Churchill once remarked that “history is written by the victors.” While Sir Winston was correct in his point of view, today’s legislative body views success as the legislation they have passed.

How do the authors of The Affordable Healthcare for America Act (HR 3962) view the piece of legislation as a great success, while many doctors and health care professionals view it as “The Great Government Overreach of 111th Congress?”

The Affordable Healthcare for America Act is projected to cost American taxpayers over $2 trillion by the year 2025, according to the Congressional Budget Office, while 31 million Americans will remain uninsured.

Adding more than $2 trillion to the national debt of the United States is not sustainable over the long term. We have to come together as a nation to tackle the budget, and introduce a balanced budget amendment to ensure future generations have the same opportunities as those generations which came before them.

Since currently there is no balanced budget amendment, we have to focus on shrinking the budget while reducing federal spending. One way to reduce federal spending is to re-think and remodel The Affordable Healthcare for America Act, not repeal the law.

Re-thinking and remodeling The Affordable Healthcare for America Act will require a lot of work from courageous legislators who truly care about future generations of Americans. Just as it is a physician’s job is to find the best solutions that work with the least risk to the patient, it should be the legislator’s job to remodel The Affordable Healthcare for America Act in a way that does not put an undue strain on the United States federal budget and our world class Healthcare system.

While in a perfect world repealing Obamacare makes for good optics, the goal of a physician is to do what is good for our patients. With this in mind, I propose “A Doctor’s 7 Point Plan for Affordable Health Care in America.”

1. Remodel, not repeal

Catastrophic Insurance Plans are the biggest linchpin needed to remodel healthcare in America and make it affordable for every single American.

Catastrophic Insurance Plans could be made affordable by acting as a safety net for those “what if?” scenarios that are beyond our control. These plans could be modeled after general liability insurance plans that protect against “what if?” scenarios in business and life.

Catastrophic Insurance Plans would cover emergency room visits, and emergency surgeries such as an appendectomy, while protecting your assets.

These plans would have a tax benefit in which 90% of annual insurance cost is refunded back to the individual when they pay their taxes, if their income falls under a yet-to-be-determined bracket.

A model similar to this one would encourage participation from Americans, as it would be insurance that is cost-neutral, or as close to 100% participation in the type of insurance that is needed, and not as expensive as what is currently demanded by Obamacare. Insurance companies would have to bid for government approval of these plans to help keep cost down.

This is a much cheaper way to encourage health insurance coverage. No one is forced to buy anything, but it is in everyone’s interest to do so. Only a fool would pass on such a program.

Cadillac plans should still available, at a reduced tax credit of 50-70%, depending on the plan. Smaller tax credits would be offered for the more comprehensive plans. No government approval for such plans would be needed. People could choose what they want to buy, or buy nothing.

There can also be major secondary insurance plans to provide coverage above the CIP. This would be cheaper than the Cadillac plans. The market will dictate what people will buy – a sort of double bell curve Insurance plan.

Medicaid will be given as a 100% tax credit as well. Government pays for those plans at poverty level, or 2x poverty, or some other predetermined multiplier.

If Insurance companies deny coverage due to pre-existing conditions, that person would go into a health risk pool, and be assigned one of the qualifying insurance plans at the standard rate. That way, insurance companies would all share in the risk.

We would need to carefully define what is covered by catastrophic insurance. Examples might include a car accident, stroke, emergency surgery, heart attack, etc. Some other options to consider covering would be victims of violent crimes, those with inborn genetic disorders, childhood cancer, and so forth. We as a nation need to reach out and help those in true need.

2. Group Insurance for Affinity Groups

We should allow affinity groups such as churches, synagogues and mosques to purchase group health insurance for their members and their immediate family members, up to the age of 26.

Small business owners would be able to purchase group health insurance through associations, or the U.S. Chamber of Commerce. Allowing individuals to purchase health insurance through groups would greatly strengthen their purchasing power, while creating value and adding benefits for their members.  

3. Allow Insurance Companies to Sell Coverage over State Lines

Allowing insurance companies to sell health insurance policies across state lines would create greater competition, which would lead to lower health insurance lower rates for millions of Americans.

State Mandates should also be removed, to allow the free-market to operate and thrive in this new environment.

4. True Tort Reform

The annual cost of practicing defensive medicine in the United States is estimated to cost 9% of the total national health care spending (Testimony of Mark McClellan MD, PhD, Administrator, Centers for Medicare & Medicaid Services, before the Joint Economic Committee hearing on malpractice Liability Reform, April 28, 2005). That’s $160 billion a year. These costs are occured due to the overuse of tests and procedures, partly due to the fear of a malpractice lawsuit.

In 2007, there were over 62 million CT scans per year in the United States, including at least 4 million for children, according to The Conference of Radiation Control Program Directors, Inc. which was referenced in the November 29, 2007 issue of The New England Journal of Medicine.

Out of the 62 million CT scans performed in 2007, one-third were partly to protect against a potential lawsuit. On average, the radiation dose from a single CT scan can be as much as 500 times that of a conventional X-ray.

The New England Journal of Medicine is predicting that 1.5 to 2.0% of all new cancers in the coming decades will be attributed to radiation from CT scans. Defensive medicine may end up putting an even larger strain on the health care system, due to the costs of caring for patients who were exposed to radiation.

To remediate this issue, the Medical Injury Compensation Reform Act of 1975, passed by the California Legislature, should be taken up in Congress as a model of how to limit potential exposure to malpractice lawsuits.The California law has successfully kept health care costs lower, as non-economic damages are limited to $250,000.

Currently only two other states, Kansas and Montana, have a cap on non-economic damages in medical malpractice. In 21 states and the District of Columbia, there is no cap on medical malpractice damage awards. This increases the cost of health care.

To resolve disputes relating to medical malpractice, there should be consideration for setting up a medical court system, similar to family court.

It has been argued that the cost of medically unnecessary, but legally warranted, defensive medicine accounts for up to 9% of total national health care spending. (Testimony of Mark McClellan MD, PhD, Administrator, Centers for Medicare & Medicaid Services, before the Joint Economic Committee hearing on malpractice Liability Reform, April 28, 2005, as well as “Do Doctors Practice Defensive Medicine?” Quarterly Journal of Economics. May 2, 1996 v111:353-390.)

Others place that figure much higher, at 20 to 25%, but these numbers are hard to verify, because the definition of defensive medicine is elusive.

The annual cost of practicing defensive medicine in the United States has been estimated as $160 billion a year by the American Medical Association.

5. Pass It, Use It

If Congress passes a remodeled affordable health care solution, Congress shall not be exempt from the coverage.

6. Drug Companies

Companies which receive government subsidies need to repay taxpayers for our investment. This could be accomplished through fair pricing. Remember that the free market does not completely apply here, since the government has given some sort of subsidy to producers. If a drug company does NOT receive any federal funding, then it should be able to charge whatever it wants. This is true free market. The free market will find the price point.

7. Community Clinics

We should support and encourage more community health clinics. Physicians, nurses, and other allied health providers could be encouraged to provide services for free. Drug companies and other large entities can provide donated services and products to help support these ventures. Full tax credits should be awarded to all involved. All services rendered by these community health centers must be fully indemnified.

The 7 Point Plan for Affordable Health Care in America is just the starting point for an open and vibrant discussion about the current state of health care in America. There is a lot that has to be done to reform health care. We must improve the quality of care for our veterans, the elderly, and every single U.S. citizen.

The United States has the world’s brightest innovators and smartest physicians. It’s time we all came together to re-think and remodel healthcare, in a way the benefits every single American.