As a family physician, I see a pressing need for affordable health insurance. I am frustrated and discouraged when patients decline testing or treatment for financial reasons. This is not just a problem for the poor but increasingly for the middle class.
President Barack Obama and Congress are pushing a health care reform package mandating that employers provide health insurance to their employees or pay a tax. It would make the federal government the health insurer to the majority of Americans.
My proposal is in direct opposition and includes the following three principles:
■ Separate health insurance from employment. This makes insurance portable, so that employees can move from job to job without losing insurance. People could buy individual or group policies through purchasing groups which would spread the risk and reduce premiums. Affordable premiums should be publicly subsidized for those who need financial assistance. People who are high insurance risks should be able to join a subsidized high-risk pool.
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■ Increase the number of primary care doctors. A primary care doctor can manage most health problems in his office, obviating the need for more expensive specialty care. Insurance companies understand this, which is why they prefer primary care doctors to drive the system. The problem is, we don't have enough of them. Unfortunately, too few medical students choose primary care because they know primary care providers are overworked and underpaid.
■ One solution is to use a different method of reimbursing primary care doctors, which some of us already have. Doctor and patient enter into a pre-payment arrangement for all office care. Patients make monthly payments directly to the doctor that count toward their deductible. It is important for patients to pay the doctor directly. That gives them ownership of their health care and their doctor is accountable only to them, not a third party. Because patients want the most value for their money, they would visit the doctor not just for acute and chronic illnesses but for wellness care, making them healthier and saving money.
For doctors there are no claims to file, meaning less overhead and fewer headaches. They wouldn't have to justify every charge to the insurance company and get 50 cents on the dollar. Instead, they would get a fair price for the work they do.
When doctors are paid fairly, there is less need to overwork to meet overhead. They can see fewer patients and have more time with each one. In my mind, the best indicator of quality of care is the amount of time doctor and patient spend together. Better pay, less work. What better incentive .to choose primary care?
Keep it private. Every American should have easy access to private health insurance. Government should play as peripheral a role as possible. It should make regulations regarding the conduct of insurers and purchasing groups; should subsidize the high-risk insurance pools; and provide vouchers to the poor for insurance premiums, co-insurance, co-pays and primary care payments. Government should determine the minimum that health insurers must cover and let them compete over how much extra coverage they offer. Insurers should be able to use standard guidelines in determining what tests, procedures and drugs they will cover but government should step in if they are too restrictive.
Although I have always maintained that American health care is the best in the world, it can be more accessible, more affordable and better. I submit these proposals as a way to achieve those goals.