OP-ED

The Conservative Way Forward on Health Care

The landslide Republican victory, in taking the House and electing some strong conservatives to the Senate, can be interpreted as a mandate to rein in government spending, and specifically to repeal ObamaCare, as these issues were clearly behind the large turnout.  There is still a very real possibility the Supreme Court will find the “individual mandate” to buy private insurance unconstitutional.  If this provision is thrown out, it’s hard to see how the law survives, since the mandate is needed to finance it.

Now is an excellent time to construct a conservative alternative vision for true reform of our health care delivery system.  Since most current problems with the health care system stem from government, a conservative plan should seek to reduce its role.

It goes without saying that the Patient Protection and Affordable Care Act must be repealed since, like all the laws passed by this administration, it does precisely the opposite of what its name suggests.   By massively increasing the health care bureaucracy at the expense of actual providers of care, it will make care harder to access and more expensive.   Many physicians will take early retirement and the already great physician shortage will be exacerbated.

The law is too large and complex to waste time foraging for items to salvage.  There is a great risk of leaving behind hidden mandates and rules that will be harmful.  Better to scrap the whole thing.  With Democrat Senators running scared for their jobs in 2012, it is conceivable the Senate would also vote for repeal (Harry Reid notwithstanding).  But not even the most generous view of Barack Obama’s ideological flexibility has him signing a repeal bill, and a veto override is out of the question for now.

It may be possible, however, to enact affirmative measures that make ObamaCare irrelevant.  Here are some common sense, free market proposals, many of which were proposed and discussed, but ignored by the President and the Congressional leadership in the run-up to passage of ObamaCare.

1. Transfer the tax deduction for health care spending from employers to individuals. This would end the absurdity of purchasing health insurance at the “company store,” a practice that limits individual choice and liberty, nourishes a sense of dependency, and promotes overuse of care.  This policy, an accident of WW II wage and price controls, was the “original sin” in health care financing; doing away with it would empower consumers to shop for the best plan for their families, which will lower premiums.

2.  Remove barriers to the interstate sale of health insurance.   There is broad agreement on this proposition.  It would increase choice and competition between insurers and drive down premiums by effectively ending state mandates that drive them up.

3. Deregulate and allow greater contributions to Health Savings Accounts.  These fabulous tax shelters give individuals more control over their health spending, and, coupled with an inexpensive policy to cover catastrophic illness (i.e., true insurance), are all most people need.  By returning most health care purchasing decisions to consumers, spending will immediately be slowed and prices curbed.   This is the conservative, free market, already tested and proven way to “bend the cost curve down.”

4. Follow the recommendations of the bipartisan Breaux Commission and give Medicare beneficiaries a means-tested stipend to buy private insurance.  This solution came during the Clinton era but was too free-market to pass muster with Bill and Hillary.  With Medicare moments from insolvency, there should again be a bipartisan consensus to reform this behemoth.

5. Transfer (gradually) all Medicaid responsibility to the states.  Federal support for Medicaid allows much greater spending than would otherwise occur.  It forces frugal states to subsidize lavish coverage in New York, California, and elsewhere.  States should have complete freedom to organize their Medicaid systems along their own priorities, in exchange for losing, over perhaps five years, the federal subsidy.  This would encourage states to find innovative ways of providing health insurance for the poor, such as individual health accounts, or subsidies to buy private insurance.

The latter two points would allow the mammoth Center for Medicare and Medicaid Services to be mothballed, though Medicare could retain a role as insurer of last resort for those with pre-existing, expensive, chronic diseases.

6. Institute a “loser pays” system for medical malpractice to cut frivolous lawsuits.  The ability to launch a lawsuit (and this applies beyond medical malpractice) with minimal financial risk is the reason behind the explosion of malpractice litigation, with all the associated costs.  Tort reform at the federal level would require the Senate to override the trial lawyers’ veto, which could be a problem.  This reform should be pushed at the state level.

7. Finally, for true patient protection, let’s propose a constitutional amendment to guarantee the individual’s right to privately contract for medical care.  This will eliminate for all time the threat to the private practice of medicine and assure that, no matter what system is in place, patients will always be allowed to spend their own money on care.

The above points are clear, simple and practical solutions. They empower the individual and greatly reduce malignant government influence and unburden the taxpayer.  It is the conservative way forward on health care.

Richard Amerling, MD, is a nephrologist practicing in New York City.  He is an Associate Professor of clinical medicine at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center.  Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981.  He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania.  He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).

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Nate
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Nate

“The PPACA OOP limits are much higher than in Switzerland.” Depends if your measuring the $ or the %. On a dollar basis you are right on a % basis I am correct. “You really believe that?” When your argument can’t stand up quack you resort to posting generalities no one can respond to? What part do you question? Rather people can sue insurance companies? It happens every day, or that people can change insurance companies, happens tens of thousands of times every first of the month. Thank you for the inteligent discourse. TTT if your going to post try… Read more »

TTT
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TTT

Every private insurance company already has a “death panel.” I don’t know why Nate is okay with them using it to bump off people who had pre-existing conditions or who reached something called a lifetime coverage cap. I also don’t know why the deaths they’ve already caused and continue to cause are less disturbing than the deaths government might cause if it enacted policies that it won’t actually enact because they aren’t in the legislation, but I’m sure it would make a fascinating yarn.

Craig "Quack" Vickstrom, M.D.
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Craig "Quack" Vickstrom, M.D.

“I can change insurance companies within a matter of days in most cases and I can sue corporations when they do wrong.”
Now that is funny. You really believe that? Oh well.

Frank
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Frank

LAUGHABLE
How generous the OWEbama crew is — as long it is NOT their money.
Always someone else’s fault. Ignore that Canadian provincial officials fly to the USA life-saving treatments. Ignore that OweBama role model Fidel has Harvard-trained surgeons fly in from Spain when he’s sick (got that, Fat Mike)?
See you in court, OWEbama. Fight your INCOMPETENCE, with our dying breaths.

Frank
Guest
Frank

LAUGHABLE
Howe generous the OWEbama crew is — as long it is NOT their money.
Always someone else’s fault. Ignore that Canadian provincial officials fly to the USA life-saving treatments. Ignore that OweBama role model Fidel has Harvard-trained surgeons fly in from Spain when he’s sick (got that, Fat Mike)?
See you in court, OWEbama. Fight your INCOMPETENCE, with our dying breaths.

Paolo
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Paolo

“I can change insurance companies within a matter of days in most cases”
Not in 36 states if you are already sick.
“Paolo who is this strawman talking about lavish Medicaid benefits?”
These are the exact words from the “conservative” plan by Richard Amerlang (see point 5 at the top).
“Obamacare exacerbates this even more by capping OOP at artifically low amounts. Very anti-Swissish.”
Wrong again. The PPACA OOP limits are much higher than in Switzerland.

Paolo
Guest
Paolo

“I can change insurance companies within a matter of days in most cases”
Not in 36 states if you are already sick.
“Paolo who is this strawman talking about lavish Medicaid benefits?”
These are the exact words from the “conservative” plan by Richard Amerlang (see point 5 at the top).
“Obamacare exacerbates this even more by capping OOP at artifically low amounts. Very anti-Swissish.”
Wrong again. The PPACA OOP limits are much higher than in Switzerland.

Nate
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Nate

I’m all for coping parts of Switzerland systems, for example we can start with people paying 30% of all healthcare out of pocket, that would solve all sorts of problems by its self. When our OOP spending went from 50% to 12% today has cauesd a large portion of our problems. Obamacare exacerbates this even more by capping OOP at artifically low amounts. Very anti-Swissish.
Before that we can start with the French model of people paying their doctor then getting reimbursed, assignment of benefits was another montrosity we need to get rid of.

Nate
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Nate

Quack, I can change insurance companies within a matter of days in most cases and I can sue corporations when they do wrong. Neither option is available when it is the government. Paolo who is this strawman talking about lavish Medicaid benefits? Maybe you should have that conversation with them? Medicaid is adequatly funded the problem is waste and fraud. If the program was properly and efficently ran we could deliver all the care to all the people that need it and do it for less then we spend today. Just as Education is adequatly funded and Medicare is adequatly… Read more »

Paolo
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Paolo

It’s ironic that the same people who complain about Medicaid’s “lavish benefits” will then complain when someone they know doesn’t get some benefit through Medicaid. I guess it’s only lavish when it’s for somebody you don’t know. If you are truly concerned about ALL Medicaid beneficiaries getting adequate care, then support adequate funding for it. In Massachusetts, bariatric surgery is covered by Medicaid. And if you are truly concerned about the future of Medicaid, then either support equalizing Medicaid payments with Medicare (as suggested by Barry) or support the transferring of Medicaid members into the exchanges, both of which cost… Read more »

Craig "Quack" Vickstrom, M.D.
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Craig "Quack" Vickstrom, M.D.

Hmmm…so it is OK when an insurance company “plays God” but not when the government does? The government is accountable in some small way to the voters. The corporation is accountable only to its board and a few major stockholders. I’ll take the government, thank you.

Nate
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Nate

Here is a real world example to consider, lap band surgery. Medicaid won’t cover it, plans subject to Ohio State regualtion wont. The employee has tried everything, they medically can’t lose weight. If this was 2014 and they were no in the exchange and the exchange said it is not allowed and to protect against people paying for it themself they won’t cover complications or any care after someone has one then this person would have no way of getting the surgery. Since this group is about to be self funded we can step back and look at the big… Read more »

Nate
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Nate

The problem is not comparitive effectivness or even rationing. They are both needed. The problem is when an entity that is responsible for paying for 50% or 100% of care is the one undertaking these endeavers. When Waswhington is presented with a budget crisis and needs to save 100 billion would you trust your life with them making the right decision? When Medicare has been over budget for the past 40 years has washington attached fraud, abuse, and inefficnecy? No, they cut reimbursements for good care and bad care. When schools are short of money do they reduce excessive pensions… Read more »

Margalit Gur-Arie
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Nate, since I have hope for everybody, I will try to answer your questions. “Germany has a Fee for service system, if we pass a bill based on global reimbursements why would we be discussing the German model as a comparison?” The bill authorizes experimentation with global payments. It is not “based” on it. If you ask me, I have no objection to fee for service. Comparative Effectiveness – You wrote here many times about your work and how you help employees use generics instead of brand name meds. This is a form of comparative effectiveness. I don’t think you… Read more »

Paolo
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Paolo

Nate – If you want to read a left-wing English paper, I suggest you read The Guardian. The Daily Mail and Telegraph are conservative. And if you are looking for stories about replacing the NHS “nightmare” with a US-style system I suggest you stay close to Upper Kentucky. You are not likely to get that opinion from any English paper or political party, left, center, or right.