Free Market Healthcare Proposal

The American people, through the mechanism of the free market, are best able to reform the health- care system. A consumer-oriented system, which is user-friendly for both the apprentice electrician and the aspiring entrepreneur, is the best way to control costs, maintain or improve quality and increase accessibility.

A system that will permit the average person, not their employer; that will allow the individual, not some corporate administrator; that will empower the American citizen, not some government bureaucrat, to make the common-sense choices as to what their needs and wants are and how much they are willing to pay to satisfy them is the best health care system for Americans.

It is not necessary for the intelligentsia or the government to decree what kind of health care citizens should have or how to finance it. This can be done by the rational choices of the American public. Unlike those who worship at the altar of planwirschaft, we believe the American people, as a whole, are entirely capable of acting in their own best interests.

It is with this philosophy that we have developed what we feel is a very unique, free-market oriented solution to at least some of the issues associated with the health care Gordian knot. This proposal contains four components. Each will address areas of the current health care system that need improvement.

Section I is a unique solution for the dilemma of those with little or no health insurance. It harnesses the forces of capitalism.

Section II addresses the issue of using the free market to make health insurance affordable for all Americans.

I - Establishment of Private Sector Operated Health Care Centers (PSOHC) A. These clinics would be primarily, albeit not exclusively, located in poor and working class, urban and rural areas. B. Investors would be given federal tax incentives to invest in PSOHCs. 1. PSOHCs would be permitted to issue federal tax exempt bonds to finance these clinics. a. Private Activity Bonds are a model for this. 2. PSOHCs would also issue a class of stock exempt from capital gains tax. 3. These tax shelters will stimulate investment of private capital. 4. Any decrease in federal tax revenues as a result of these tax shelters would be offset by increased income, payroll, and sales taxes generated from the creation and operation of PSOHCs.

C. PSOHC Revenues 1. PSOHCs would obtain revenues from treating patients. a) Types of patients 1) The uninsured, whose income does not permit them access to government operated county clinics, and those with only catastrophic insurance a- Payment arrangements would be made between the PSOHC and the patients. b- This is a retro model. There was a time when people paid physicians directly or by installments. c- Health Savings Accounts are also effective for this. 2) Medicaid members a- Some may prefer using PSOHC physicians than those who participate with Medicaid or those with government clinics. 3) Medicare members - same as 2)a 4) Commercially insured patients - same as 2)a D. PSOHC Provider Staff 1. Tuition forgiveness a) Physicians, nurses, and others would be encouraged to work for PSOHCs by permitting tuition forgiveness for those practicing at the PSOHCs located in impoverished areas. b) Without the burden of tuition loan repayments, many doctors would work for less salary. 2. Malpractice liability a) Malpractice awards against providers working at PSOHCs located in impoverished areas would be limited to specified legislated amounts of settlements, thereby reducing malpractice insurance premiums. 1) Malpractice limitations make sense, since these are economically depressed areas. 2) A model is the California Medical Injury Compensation Act of 1975. E. Benefits of PSOHC's 1. Increase accessibility to primary care physicians a) Poor and uninsured will have more access to primary care. 1) This will reduce the amount of unnecessary emergency room visits. 2) More doctors means more market driven fees. 3) A recent study published in JAMA stated that owning health insurance does not necessarily mean access to health care. 2. The uninsured will have an alternative to not seeking medical care. a) The result would be a healthier population, fewer Medicaid expenditures and fewer uncompensated medical services. 3. More hospitals can continue to function. a) They will not be bankrupted by uncompensated care.

II - Buying Health Insurance A- Associations need to be formed for small groups (i.e., fewer than 5 employees, sole proprietors, unemployed and self-employed individuals) to buy health insurance. 1. Many states prohibit the organizing of groups for purposes of buying health insurance. 2. Insurers do not like to contract with such groups. 3. Legislation needs to be enacted to establish these groups along the lines of ERISA. 4. Individuals and small business owners would have the purchasing power of large groups. 5. Groups can be national, statewide or local.

B. The public should be permitted to buy health insurance across state lines. 1. Costs for similar insurance policies vary from state to state. 2. Politically motivated state mandates increase costs. a) Without mandated procedures, premiums for insurance in one state will be cheaper than another. b) One state may mandate fertility procedures be included, yet a 59-year-old self-employed carpenter does not want such a benefit. Buying insurance from another state that does not mandate this decreases costs.

III Incentives for Primary Care Physicians A. There is a shortage of primary care physicians. 1. Family practice, internists, obstetrics-gynecologists, and pediatricians are not compensated as well as specialists, yet they are the gatekeepers and first line of medicine. 2. These practices are essential to easing the emergency department crisis that exists even in affluent areas. B. Increase public health service commissioned officers corps 1. More physicians would be available to practice in poor urban and rural clinics. a. Similar to military academies, participants can receive tuition-free education and stipend and owe five years service after completion. 2. Funding for this initiative will be from a windfall profits tax or excessive profits tax for malpractice awards and attorney's profits.

IV Malpractice Reform A. Tort liability should be for medical and compensation only for PSOHCs. B. Frivolous lawsuits should be policed by American Bar Association and Department of Justice. 1. Use Dragonetti lawsuits. C. Establishment of malpractice courts 1. Courts modeled after family and patent courts a. Refer to American Enterprise Institute proposal of 2002. 2. Jurors should come from medical and legal field. a. Since this is not always possible, mandate that jurors are given full pay for service. This will ensure more diverse jury pool.

The enactment of these proposals will increase access to health insurance and health care; make health care more affordable and accessible to all; eliminate unnecessary costs; address the concerns of providers, payers and the public and make the health care system more effective and efficient.

The use of PSOHCs is truly unique. The closest is what Wal-Mart is doing. As referenced, there are models in other industries for the financing of this plan and the tax shelters.

Providing less salary in return for less expense for physicians practicing at PSOHCs is another example of capitalism at work. The forgiveness of a few hundred thousand dollars of debt and less malpractice insurance expense in exchange for less salary is a valid one.

The idea of purchasing health care across state lines has already been proposed in Congress. Some presidential candidates have included the idea in their platform.

Forming associations for the purpose of buying insurance is antithetical to the insurance industry, but it is an idea whose time has come. The notion that such groups will be prone to fraud is not valid. Most small business owners need to go to work and will do so regardless of their health.

A windfall tax for excessive malpractice judgments is an idea that will be a litmus test of sorts. There are those in government who favor windfall taxes for certain industries they think are being unjustly enriched. This will permit them to apply this principle to one of their major political constituencies.

It is important to note that this proposal is not a magic potion. It is not intended to provide a utopia - nor should it. After all, utopia means "no place."

The reaction by some health care industry groups - think tanks and professional organizations - to this proposal has been favorable. Indeed, one presidential candidate, Republican Congressman Duncan Hunter of California, is considering adopting these innovations as part of his platform.

The uniqueness of this plan is that it provides solutions to some intractable problems using the truly innovative and creative free market solution of investors investing in areas of medical and social concern. It should be welcomed by anyone who believes in the American economic system.

*Michael P. Tremoglie is an advisor to the presidential campaign of Representative Duncan Hunter who is seeking the nomination of the Republican Party. He was formerly director of managed care at Temple University Health Sciences Center.*

This is key. Extracting the insurance companies tentacles (not to mention government regulations) from the medical market will go a long way toward reduced costs.

eh. so so. doesn’t address many issues.

RHIOs are failing right now that were only formed just a few years ago. hard to partner across corporate lines i guess. especially in such a competitive industry. or who is going to run these centers for those without insurance? the government?...wonderful.

the idea of making malpractice awards capped for those treated at the centers, invites issues with quality.

i like forgiveness of loans for physicians willing to work in areas that need healthcare providers.

why are they not addressing one of the biggest issues....and that is the fact that the docs and the patients are both getting squeezed by insurers. it is not unusual for the insurer to deny valid claims and not pay valid bills hurting both parties. state insurance commissioners are useless in my experience so there is no one really enforcing that they follow coverage agreements except benefits administrators in companies.

you know.....i can’t figure out who all these people are who have no healthcare insurance when you look at the numbers of people (poor or old) covered under government programs. something like 1/4-1/3 of the american population i think.

most responsible folks do not quit jobs when it means they will be without health insurance.

so hopefully this should only leave temporarily unemployed folks for whom an emergency program should be established possibly.

What do PSOHC’s have to do with RHIO’s.

They are too completely different things.

As far as this question of yours “ or who is going to run these centers for those without insurance? “
This indicates that you either did not read or did not understand the proposal.

The purpose of the PSOHC’s is for the private sector to operate healthcare centers for all of those even without insurance who will pay cash - just like people used to do.

Please reread the piece and if there is something you do not understand ask a question - do not criticize something that was not stated.

“most responsible folks do not quit jobs when it means they will be without health insurance”

err...

Health Insurance is not medical care, it is merely a method of ensuring payment for medical care.
Why do you consider how I pay for medical care any of my employers business?
Granted, as an employment perk, it is very attractive to have a company provided policy, but is is merely a “perk” provided in lieu of wages.
Most company health insurance policies have increased in costs annually, at such astronomical rates (10-20%), that few private small to medium companies can afford to offer this “perk” at affordable rates to their employees.
IMHO, it is past time to shine a very large spotlight on the aspects of “health care” that seem to be least productive in terms of actually providing medical care-namely the Insurance industry, and the government agencies that regulate them, to the detriment of patients and health care providers.

Let’s stop demonizing insurance companies. They finance healthcare. They take our premium dollars and manage them in such a way that they can pay for the expensive and sophisticated equipment and training that we can get.

I can just as easily talk about the American consumer who will bitch about paying a doctor while driving 60 miles to go to a casino to gamble.

Let’s stop demonizing insurance companies. They finance healthcare.They take our premium dollars...

I hope you understand the obnoxiousness of this oxymoron. They finance nothing. Our premium dollars finance everthing, including a vast army of health care bureaucrats who do little to deliver healthcare - among which I presume you are numbered.

Neither however even if I did so what?

Since when is making a profit bad.

Do you go to work? Don’t you get paid? Well that’s a profit.

I guess you prefer a socialized nonprofit healthcare system?

No thanks I would rather not have the USSR’s healthcare system nor the Canadian one nor any other.

The insurance companies finance nothing?

I suppose then you either like socialism or you are ignorant or both.

Let me see you pay out-of-pocket for a heart transplant. Oh what’s that you say you couldn’t. You would need insurance you say.

Like a good little leftist you know nothing.

( Oh and please don’t say I shouldn’t insult you because I am just returning your the insult you made when you said “a vast army of health care bureaucrats who do little to deliver healthcare - among which I presume you are numbered.”

How dare you impugn my integrity you ignorant jerk!

What are you talking about?

You know I wish you people would stick to the subject at hand instead of trying to prove how smart you are - which doesn’t matter to me one way or the other.

Read the article! Don’t talk to me about how terrible insurance companies are. The article is not about insurance companies.

Don’t tell me about socialized medicine the article is not about that.

Truthfully I did not post this article to hear your opinions about how terrible capitalism is or how much you like socialism or don’t like socialism. Two freepers were the ones talking the socialism route not me.

So save your time and mine.

“Free Market” vs. Socialist is the topic at hand when it comes to healthcare. Only one candidate has it right on healthcare and using the free market version as opposed to government mandated socialism.

You are free not to post, free to ignore and there’s no need to announce it. It’s simple...scroll right on by what you choose not to read/watch/listen to. Some here may be interested in the links I posted, unlike you.

Apparently time is one thing you have an over abundance of, since you took the time to reply at all.

The insurance companies finance nothing? I suppose then you either like socialism or you are ignorant or both.

No, the insurance company, and you,lk you chisling idiot, finance nothing. Everything is paid for out of premiums you smarmy jerk.

I have nothing in particular against insurance as a mutual contract between a group of people to spread risk.

I have no problem with a company charging reasonale fees to manage such a pool.

I have a big problem with smarmy jerks like you who put on airs of altruism. Man you have all the sincerity of a funeral director.

Don’t tell me about socialized medicine the article is not about that.

Don't try to tell us that a bunch of proposals for new laws about new kinds of health insurance is a "free market" solution. We are in an era of highly regulated insurance pools and direct government subsidies. It looks nothing like a free market and even more rules to mandate more market changes does not create a free market.

A free market will occur when the government pulls out all together, and when ALL significant transactions are private transactions between individuals who want medical service and the doctors who will provide them.

I don't know whether that is the system that we want, or that we can get there from here.

But you ignorant self-aggrandizing fraudster - don't go telling anyone here about free markets. There is none in this area, the insurance companies neither create nor operate in a free market, and these rules only create new regulated options and entiies.

Yes we read the proposals. They read like the disclaimer forms on a software package, which you have to hope will work.

Bingo.

Also, I'd like to see the enumerated constitutional power that grants the federal government any right to control health care in any way in the first place. As many times as I read the document, I just can't find it...

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.