There’s been extensive discussion about healthcare dysfunction.  We should be considering solutions.

 

Hospitals should not be allowed to employ most office-based physicians.  Hospitals could still determine which physicians are privileged to work in the facility, and they could still employ physicians who work primarily in the hospital, such as anesthesia and pathology.  Hospital ownership of physicians encourages over-use of the facility and is averse to the patients’ interests.

 

Insurance companies should be allowed to sell almost any product that the consumer prefers.  There should be no requirements to cover specific evaluations or treatments.  There should be no requirement to own medical insurance.

 

Health Savings Accounts should continue.  Insurance costs and HSA contributions should be deductible from taxable income.

 

Insurance companies should not be allowed to require pre-authorization, or at the least, there should be a fee paid by the insurance carrier to the physician each time pre-authorization is required (Perhaps $100 per pre-auth).  If the insurance carrier is unhappy with a physician’s performance, that physician can be removed from the carrier’s panel.

 

Insurance carrier physician panels should be easy to find and accurate.  Unless you know the panel, it’s impossible to understand the product.

 

The CPT billing/reimbursement system should be replaced with the UCR (usual, customary, and reasonable) system when used for office visits.  Because there is no effective and accurate means to measure work for an individual an office encounter, the documentation and billing efforts are a detraction and an expense without value.  CPT may continue to be appropriate for procedures and hospital care.  UCR was effective in the 1970s.  If much of the primary care is a direct patient expense, the patient can decide whether the benefit is worth the cost.

 

Prices for all medical services should be transparent.  Medical offices and hospitals should be required to post their charges and inform patients before providing services whenever possible.  Price lists could be web-based, allowing patients to shop before buying.

 

Medical liability should be replaced by a “Workman’s Comp” model.  In the event of a claim, a panel of experts could decide harm and compensation.  The experts could also decide if true malpractice caused the injury.  Culpable physicians could be disciplined or even lose their license.

 

A basic level of healthcare should be available to everyone.  Indigent or Medicaid patients could be offered a public clinic with a Nurse Practitioner.  Inexpensive generic drugs and vaccines could be provided.  Society should not be expected to supply the extremely expensive new drugs that are unaffordable for almost everyone else.  Taxpayers could decide which services are important enough to provide at public expense.

 

Medical records should be owned by the patient and not by any healthcare system.  Access to records should be controlled by the patient.

 

Medicare parts A and B can remain unchanged.  Medicare Advantage should be recognized as a failure and eliminated.  Medicare supplements should be less regulated similar to other policies.

 

Medical insurance should not be controlled by employers.  Employers could contribute to the cost of insurance and suggest options, but all health insurance should be portable if a patient changes employers.

 

 

I invite comments and suggestions.  Perhaps we can develop a comprehensive document to suggest to Congress.