The healthcare system in the United States is broken. I am not going to blame Medicare, Medicaid, or Obamacare for the issues we face today. Obamacare may have caused healthcare premiums to increase due to insurance companies covering pre-existing conditions. Just like a bad driver will pay more for car insurance, a sick person will pay more for health insurance. However, the constructors of Obamacare were not complete fools. They included the individual mandate so they could get as many young people into their approved health insurance plans as possible. That is why there was a huge worry that repeal of the mandate in 2017 would cause a “death spiral” due to the increase in premiums from the lack of healthy people buying insurance. Either way, healthcare premiums increased when Obamacare went into effect. Here’s the thing: I understand the basis for trying to implement programs like Obamacare. The issue is healthcare is too expensive in the United States. However, the Democratic Party wants to keep putting more regulations and mandates into the healthcare industry while most of the Republican Party does nothing. When people complain about the lack of a Republican healthcare plan, it is legit because I think the Republican Party is just pandering and trying to pretend like they are doing something. However, virtue signaling is not going to save anybody. Instead, we need to focus on solutions. First, let’s start with one of the true enemies of the healthcare system: insurance companies.
One of the reasons why I am critical of Obamacare is because instead of weakening health insurance companies, they make them a necessity. That being said, insurance companies have their plans approved by the Fed and have to provide a certain amount of services to be purchasable. However, those same insurers will limit the amount of money they spend by limiting providers the insured can receive healthcare from. This middleman game is another reason why I dislike health insurance companies and Obamacare for enabling and making them richer. But I have a question: why are we using an insurance model for healthcare? I mean, insurance companies are just waiting for their consumers to mess up so they have an excuse to charge more and make a profit. Also, many Americans wait until after they are sick to get insurance rather than getting insurance when they are healthy. That behavior leads to all the pre-existing condition controversy. People do not wait to get car insurance after they are in a crash, do they? It would make more sense to purchase healthcare when one is healthy to prevent such a disaster. However, people with pre-existing conditions should still have access to healthcare. That is another reason why I cannot completely dismiss Obamacare. However, instead of naively calling to “repeal and replace” Obamacare, let’s propose other solutions.
First, let’s start by cutting the bureaucratic red tape and let physicians be physicians. We should focus less on access to health insurance and focus more on access to a physician. It may sound foolish when you say it out loud, but the reason it sounds that way is because of the current health insurance model. According to a 2016 survey by the Physician Foundation, 72% of physicians say that external factors detract from the care they are able to give. The same survey says 60% of physicians feel that electronic health records detract from patient interaction. Also, the majority says regulatory, paperwork burdens are the least satisfying aspect of medical practice. It is not just the federal mandates that are causing issues though. Reuters has reported that a third of US healthcare costs are for administrative purposes. One reason is that hospitals are trying to get more money from exacerbating a patient’s medical condition. By “upcoding”, hospitals can get more money from the insurance company at the expense of the patient. This dance with a middleman is costing Americans lots of money and needs to stop. If we need healthcare we should go to a doctor without having to wait for some private insurance company or bureaucrat to tell us what we need. Patients should have faith in their doctor rather than a person that is being tossed to some employed physician. The idea of electronic health records may sound like a good idea, but it turns people into robots rather than humans.
Another solution is to stop restricting the supply of doctors. Possibly due to the pandemic, America has seen a record-high amount of medical school applicants. Some have dubbed this “the Fauci effect”. The increase in doctors should be a good thing. The more doctors, the more patients that can be treated. However, that is not as easy as it sounds and you can once again blame the federal government for that. The cause of this is the Balanced Budget Act of 1997. This act put a cap on the number of medical residencies the Medicare program would fund. I am not the biggest fan of federal government spending but considering the shortage of physicians in the US and useless ways the Feds spend money, increasing the number of medical school residents sounds like a better use of taxpayer funds. But that raises another issue: hypothetically if the US does increase the supply of licensed physicians, wouldn’t we have the same issue as before? The answer is probably yes and that is why we need an alternative to the health insurance model. An example of that would be Direct Primary Care; DPC.
What is DPC? It is an alternative to the broken system and therefore better… just kidding, but I think it might be better for a significant number of Americans. DPC is essentially doctors providing healthcare without insurance. That’s right. No bureaucratic middleman or insurance company. Just patient and doctor like it should be. An example can be found in Frisco, Texas. 7Health is a medical clinic that throws out the common health insurance model that I have been ragging on. Instead, the clinic offers a subscription-based model. For a set monthly fee, members gain access to a variety of services for $7, including flu shots, lab tests, joint injections, and more. These services can provide preventative care to Americans so they will not have to deal with administrative costs. However, I need to be fair. While the clinic does provide services like casts and urgent care, other services such as ambulances and dental are not covered. I believe health insurance should only cover things that occur outside your control such as injuries sustained in a crash or other severe injuries. Chronic illness management can be covered by clinics such as 7Health rather than big insurance companies and hospitals. As for prescription drugs, that is an issue that involves insurance companies, drug companies, and the federal government. But not all places have access to DPC providers. In fact, building a new healthcare facility in the US has its own set of obstacles. Those obstacles are called Certificate of Need laws.
You may not have heard of this. A Certificate of Need (CON) is essentially permission to construct a new healthcare facility. Not every state has a Certificate of Need law but the supermajority does. States were incentivized by the federal government to pass CON laws in 1974 with National Health Planning and Resources Development Act. The idea was that limiting healthcare facilities would lower healthcare costs. However, that has not been the result and as such we got Obamacare. At least Congress repealed the mandate in the mid-1980s. But even without the mandate, almost 75% of the states have CON laws. These CON laws have been shown to be more of a burden on the supply and costs of healthcare. I hope state legislatures begin making moves to repeal their laws as another step to fixing this country’s healthcare system.
To reiterate, the United States’ healthcare system is broken. However, changing it does not require putting new regulations on top of the old ones. Instead, the solution could be changing the way we deliver healthcare and removing some of the useless regulations in the system.