Many of my patients have told me that the political discussions about health reform have been far too complicated for them to comprehend. They know what they want, they know what they need, and they know that they haven’t been getting it from the Affordable Care Act. They weren’t confident they would get it from the American Health Care Act either.
Everyone wants the same thing: To be taken care of when they are sick, to have access to a doctor, and to have access to the places she or he wants to send them for tests and treatment.
Unfortunately, insurance coverage has never guaranteed this care. This was true in the 1930s when it was first developed, and it is even truer now, when the promise of insurance has expanded to supposedly cover every health care need. But it can’t get you in to see a doctor if their schedule is full, and it can’t cover your visit if your deductible is too high.
This is why the mandates don’t make sense. The government is forcing you to buy something that isn’t an automatic gateway to the very doctors and nurses needed to treat you, the radiology suite necessary to do your x-ray, the lab to draw your blood, or the pharmacy to fill your prescriptions.
This is why Obamacare doesn’t work. It mandates preventive services that raise your premiums sky high even if you view prevention as taking place in a gym or at a salad bar. Of course, it is laudatory to pay towards health services you will never need—until you consider that five percent of Americans generate 50 percent of the health care costs. You can’t help but wonder: If the government wants to take care of its citizens by paying copays to encourage cancer screenings, for example, why not do it directly, rather than ask my 26-year-old patient to see it reflected in his premiums?
For starters, that was all that was really needed to fix Obamacare—get rid of the mandates and add a catastrophic option designed for young people who didn’t want or need all the so-called essential benefits of Obamacare. Create high-risk pools for those who were so sick they were difficult to cover. Let the government subsidize these pools. Increase tax deductible Health Savings Accounts for those who want to buy their own health care and negotiate the price.
Don’t strip away all the Obamacare taxes all at once, but remove the job killing medical device tax. Republicans should tell Democrats that they won’t touch Planned Parenthood, because it has nothing to do with Obamacare. Same to Medicaid. Offer that as an incentive for Democrats to vote for the new bill. Keep the Medicaid expansion, but make it more efficient by building practice teams (with doctors, nurse practitioners, business managers) as in Ohio and bridge-to-jobs programs and premium buy-ins for more services as in Indiana.
My patients understand that the purpose of government is to protect them from Bubonic Plague, to provide vaccines, and to make sure their emergency health needs are taken care of. Insurance regulations and Prixe Fix policies promoted by insurance lobbyists and endorsed by politicians for contributions are in the weeds. My patients can’t relate to them, nor should they. Add a la carte choices, and smaller insurers will be drawn to participate. Premiums will come down due to more competition. Lower premiums and more choice is something my patients can understand.
It’s simple: no mandates, more choices, catastrophic option.
Marc Siegel MD is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News Medical Correspondent.