Posted on 03/13/2021 6:03:13 AM PST by Kaslin
Can we transform the entire health care system by empowering the roughly 60 percent of patients who are in private health plans? That’s the premise of a new book I just read by Todd Furniss (@TFurniss on Twitter). The author of The 60% Solution: Rethinking Healthcare, believes there are five major reforms necessary to empower patients and help them get better care at better prices. These include: (1) change governance, (2) modify health savings accounts (HSAs), (3) clear prices, (4) standardize accounting and information technology in the medical industry and (5) emphasize primary care.
Why reform how medical care is governed? The theory of regulatory capture posits that over time regulatory agencies will become captured by the industry they regulate and promulgate self-serving regulations to benefit the industry. An example of this is state medical boards, which are composed mostly of physicians. These boards regulate the practice of medicine and protect it from competition under the pretense of patient safety. This process began more than a century ago with the infamous Flexner Report. Abraham Flexner was neither a scientist, physician or medical educator. Yet, with backing from the Carnegie Foundation and the American Medical Association (AMA), Flexner’s 1910 exposé resulted in the closure of more than half of medical schools. The 82 shuttered medical schools were deemed substandard by the AMA.
With the AMA’s backing, Flexner also succeeded in making physician training more difficult and time consuming. Instead of attending college with a major in medicine, students were required to get a 4-year degree before attending one of the few remaining (elite) medical schools. This purposely made physician training more selective and costly. As the saying goes, this was a feature not a bug.
Removing many of the barriers to practicing medicine would increase access to care by boosting the supply of physicians. State medical boards, caps on physician residency slots and stringent requirements for foreign medical graduates all function to reduce the supply of physicians, limiting competition and boosting fees.
Tax law began stripping away consumerism in medicine nearly 80 years ago. During WWII ship builder Henry J. Kaiser was not allowed to raise wages so it sought permission to offer health insurance benefits instead. In 1954 Congress affirmed health benefits were nontaxable, while paying for care out-of-pocket required the use of after-tax dollars. This tax advantage is largely why today about 90 percent of medical care is paid for by someone other than the patient. This also explains why prices are not transparent and providers do not compete for patients on the basis of price.
One way to boost competition and increase price transparency is to put more health care dollars back under the control of patients. That’s where HSAs come in. To help patients pay for more medical care directly, they need a way to save for physician visits. Under current law there are strict requirements for who can have an HSA and how much they can save. This needs to change. If patients pay for care directly the price of medical services will become more transparent as is the norm in other industries where industries offering goods and services compete for customers on price. For services covered by health plans consumers still need the ability to compare prices.
Why standardize accounting and IT? The purpose of accounting to compare costs and profitability across firms applying the same standards. Yet, diverse accounting standards obscure both costs and prices in health care. Hospitals do not compete on price. Thus, they often don’t even know the actual cost of a given procedure. Indeed, prices vary from one hospital to another.
The difference is often huge. In addition, the current system of huge list prices, secret insurance prices and nonexistent or super-secret cash prices has gotten worse over time.
Why standardize health information technology? Health IT is widespread but most systems can’t easily share information across platforms or institutions. This often leads to redundant and unnecessary care that is wasteful. By contrast, almost any brand of computer can run a variety of browsers (Edge, Chrome, Firefox, etc.) and view nearly all websites on the Internet. Why can’t health IT be like web browsers? Patients need to right to easily share medical records between providers.
Finally, the author believes patients need to place greater emphasis on primary care. Consumers should know their doctors and be able to easily consult with them before chronic conditions occur, not just periodically to manage disease once it develops. This is more likely to occur when HSAs are expanded, prices are transparent, and barriers to the practice of medicine are lowered.
These five reforms are not controversial among those who believe in patient-centered health care. Unfortunately, too many in the medical establishment have a vested interest in the status quo. Also worrisome is whether President Biden embraces the leftist belief that patients should never suffer the indignity of reaching for their wallets following a medical service.
America’s present health care system is a super- expensive, bureaucratic hairball system that can’t be reformed, and as such, is on its way to collapse.
As a simple back-up to run along our present system, and pressure-release valve to this coming crisis, we need to allow and incentivize doctors to accept CASH payments to run along present system. No 3rd parties, no government. You need a procedure? doctor publishes his prices. It won’t work everywhere, but once it starts, you would be surprised how quickly it develops and the innovations is produces.
Almost one third of clinical doctors in the USA are foreign born.
Medicine has pretty much become a mirror image of the information technology profession in the USA.
Unless you have elite skills, and a deep passion for the job, native born American college students should probably look elsewhere for a career.
Let ARNP become the first line of primary care, with referrals to MD/DOs when a patient has more than a cursory set of symptoms for chronic illness. Most of what doctors used to do in the days of Kildare and Gillespie can be done today by ARNPs.
What terrifies me is that it's just not Biden who believes Americans shouldn't suffer this 'indignity.' I'm afraid FAR too many Americans agree with him.
I think this article offers some terrific, rational ideas about how to bring sanity back to our health care delivery system. Unfortunately, we're dealing with a significant percentage of the American public that isn't rational and is largely financially illiterate. For better or worse (WORSE, way worse), too many Americans believe health care is an entitlement, something that the Constitution guarantees for them irrespective of their ability to pay for that something.
If Americans start believing that about tech products (as the author uses as an example of functioning consumerism), then Apple, Dell and Samsung are just as screwed as the local family practitioner us. At the rate of our current decline, that just might happen sooner rather than later, sadly.
I believe one of the objectives has been to destroy independent medical practices. Independent doctors were opinion leaders.
They were independent of government largess; the were a source of non-government power.
The current system has made them into high-paid, bureaucratic technicians.
I believe one of the objectives has been to destroy independent medical practices. Independent doctors were opinion leaders.
They were independent of government largess; the were a source of non-government power.
The current system has made them into high-paid, bureaucratic technicians.
Standardized accounting for healthcare 🤔? You could argue that has been standardized for 50 years by the Federal government through the mechanism known as the Medicare Cost Report.
Sorry for the double post.
“Reform” is always bad.
How about establishing a free market in health care, and break up monopolies - e.g insurers should not be providers as well.
Make it illegal for the AMA to have a say in how many doctors and nurses graduate each year! These people have no right, but they lobby to squeeze the pipeline to a trickle.
Some more good ideas that don’t stand a snowball’s chance in hell.
Anybody seen Trump’s initiative to make health care pricing public information?
I didn’t think so. Neither have I.
Anyone have a doctor that you cant understand? Has a doctorate from the village school of obogo in Tanzania? Is happy making what ever this puke government gives him because its more than the wooden nickels he was paid at home? Welcome to the transformative healthcare system of America
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