Ideas for Healthcare Reform

Mandatory Annual physical exam

This can be done as a public health measure. It would identify epidemic diseases early on. For example high blood pressure, obesity, diabetes could be documented and treated. It would provide accurate data on the incidence and prevalence of disease. It could provide a basis for actuarially determining insurance premiums. By adopting a healthy lifestyle, insurance premiums would be reduced.

Require mandatory Health Savings Accounts

This will force people to save and pay for their own medical care in the same way they are forced to save for retirement with social security and save for medical care in retirement (Medicare). If tax deductible, the government will pay a portion of the cost. 

If the patients are paying with their money, they will spend it more wisely than they would with insurance dollars. They will be responsible for paying for their own healthcare. Insurance would be available to help as the patient determines. 

If patients have money, they are less likely to declare medical bankruptcy. This will decrease one source of stress and anxiety leading to suicide. It is thus a mental health reform. 

The more money accumulating in an HSA, the less dependent the patient is on an insurance prepayment plan. Insurance can go back to its original purpose- covering rare catastrophes that for the grace of God could happen to anyone. (See insurance reform below) 

Allow the government to contribute to an individual HSA the additional cost of health insurance for working patients with chronic illness that is genetic or of unknown cause.

This might include patients with juvenile diabetes, cystic fibrosis, multiple sclerosis for example. Patient would still be responsible for the base premium plus any additional premium as a result of an unhealthy lifestyle. Patients unable to work would still have medicare disability.

Eliminate group health insurance.

Individual premiums should be actuarially determined. Companies could still contribute to an employee’s HSA as a fringe benefit but patients would purchase insurance on their own with everyone on a level playing field. This would encourage each patient to live a healthy lifestyle and not have unhealthy lifestyles subsidized by others. Since insurance claims would be paid into the HSA, patients could choose from a variety of plans. When first starting in the workforce, without much money in the HSA, patients could opt for insurance paying 90% of the bill. As the HSA accumulates money, patients can afford to pay more of the bills. The insurance could gradually be responsible for less of the bill and could eventually be eliminated except for catastrophic coverage.

Make contracts between insurance companies and health providers illegal.

Insurance is a contract between the insurance company and the patient. Patients should not have to purchase insurance merely to obtain discounted prices for medical services. The service should be offered at the same price regardless of the insurance or lack thereof. Insurance should pay the patient not the provider and pay the claim directly into an HSA. Together with price transparency patients will be able to shop for price. Hospitals that make quality measures public will enable patients to shop for value.

This will eliminate networks. These are anti-competitive, eliminate competition and raise prices. Patients will not be forced to see a doctor solely because that doctor is in network. They may see any doctor of their choice.

Make it illegal for doctors providing hospital services to bill patients. Rather they should negotiate their fees with the hospital. No Surprise Billing!

Doctors can negotiate their fees with the hospital. Hospitals would then present one Bill to the patient for a service instead of 4-5 separate bills for one procedure.

Require that all health establishments and pharmacies post the cash prices of their products or services. Price transparency.

Currently these prices are negotiated with the government and insurance companies. They are secret. Patients should be able to easily compare prices at different hospitals and doctor’s Offices. This is the beginning of promoting competition among healthcare providers.

President Trump has issued an executive order for this change in 2021. The American Hospital Association is suing to block this executive order.

Use tax laws to encourage physical fitness and a healthy lifestyle.

Medicare disability is a substantial cost to the government. By increasing the medicare tax on individuals more likely to be disabled,  would encourage a healthy lifestyle.

Reform patents for drug and medical devices. Strictly enforce antitrust laws to prevent drug companies from fixing prices.

Currently patents give drug companies a monopoly for a fixed number of years in return for developing a new drug or medical device. This is done as an incentive for the company to develop the drug or medical device and go through the FDA approval process. This works well for inventions in general. In general, the new invention must compete in the marketplace and is still subject to supply and demand.

This does not work well in Medicine. If a new treatment is developed that cures a previously incurable cancer, a the patient will likely pay all he could afford to get it. If insurance pays, it will just raise premiums to cover whatever the drug company asks. What if drug and medical device patents ran out after the company made a predetermined profit e.g. five times the development costs? Another thought. What if the government bought out the patent rights at a profit to the drug company and licensed the manufacture of the drug to several companies. They could amortize the patent cost over many years from the license fees and patients would immediately have generic prices.

Legalize controlled drugs

Currently drug and alcohol addiction are major public health problems. We have treated drug use as a legal problem but it has not reduced the problem. It does not work for the same reason prohibition did not work. These problems are medical not legal. The question is how do we solve the problems medically. Once drugs are legal, we can register both the dealer and the user, tax its use and use the money to provide treatment. We will also save money from decreased legal costs including a decrease in the prison population. We can also raise insurance premiums on drug users based on actuarially determined rates. Similarly alcohol abusers will be identified on annual physical exams and their insurance rates adjusted upward as well. These financial incentives may help to decrease the problem of drug use before addiction sets in. At least its shifts the healthcare costs of these unhealthy lifestyles to the users. Would this decrease the suicide rate?

Increase the earned income tax credit so that working families are guaranteed an income above the poverty level.

Poverty has been identified as a major cause of stress in our society and thus a major cause of mental illness. We have spent untold trillions of dollars since President Johnson declared war on poverty; yet we have barely made a dent. Warren Buffett has floated the idea of increasing the earned income credit for working families so that each would have enough income to be just above the poverty level. Would this decrease the level of stress and anxiety? There would be no need for a minimum wage as all workers would be guaranteed an income at least above the poverty level. The consumer and businesses would benefit from the cheap labor allowing prices for goods and services to decline. This would raise our standard of living and making the country more competitive in the world markets. Medicaid would largely be necessary as would food stamps and subsidized housing. Poor people could get the same care as everyone else.

Ideas to improve mental health

Use the tax law to promote 2 parent families and religious attendance or attendance other social clubs.

Promote social networks to support drug addicts and alcoholics.

Eliminate poverty using the earned income tax credit.

Legalize drugs

Promote physical exercise, meditation, yoga, tai chi