We have not had a true free market for healthcare services or insurance in more than 60 years. Previously, patients paid physicians and other healthcare entities and were reimbursed for major medical issues by their insurance. Physicians individually set prices as necessary at a competitive rate of a few dollars for a visit or patients could barter with their own goods or services.
Healthcare list prices are inflated and unrealistic. Most payer entities have deals that cut the price significantly. Only the self-pay patient gets the full list-price bill sent to collections for payment. Such patients should get the best price because direct payment eliminates the middlemen and preempts costly coding, billing, and appeals.
I agree with Dr. Kleinman that the current solution is not working for the 15.1% of the population below the poverty line. I would, however, go further to say that the current system is not working well for any party, except the insurance industry; their stock prices and chief executive officer salaries keep rising. Government and insurance companies increasingly are intimately involved in the patient-physician relationship, artificially modifying care decisions with administrative verifications, pre-certifications of tests, prior authorization of medications, retroactive denials of care payment, etc. We all agree that the current healthcare environment does not work to improve patient involvement in his or her own health self-maintenance or healthcare option decisions.
A true free market healthcare, patient health-freedom, and major-medical insurance reimbursement environment would succeed with no government oversight or startup and maintenance expenses.
People will make better choices when directly responsible for the risks and benefits—and associated costs—they experience. They must be free to make lifestyle choices and choose healthcare options, insurance plans, etc., based on their value systems, because their health is their responsibility.
People should be able to purchase low-cost, high-deductible major medical health insurance plans across state lines with tax-free health savings accounts, as individuals or groups. These insurance plans must reimburse patients based on their health and healthcare choices, not provider networks or artificial administrative processes that are designed to deny care options and ultimately drive up care costs.
Unlike the current employer/employee sponsored system, an individual or group system would remain in effect through job changes and other work-related issues. Insurance companies should compete across state lines to offer people direct health insurance plans that meet their needs, value systems, and cost structures.
All aspects of healthcare—from physicians, labs, hospitals, pharmacies, and pharmaceutical companies to insurance companies—must compete in the free market to provide an efficient and economical environment for patients to exercise their health freedom free will.
For the population that lives below the poverty level, they too must be invested in their own care and self-maintenance. Perhaps the taxpayer system should provide minimal coverage for their major expenses while they shop in the competitive marketplace for their healthcare needs and self-maintenance wants.
Another option, the Zarephath clinic model, as detailed by Alieta Eck, MD, could replace the expensive and unsustainable New Jersey Medicaid system. The plan proposes that doctors of all specialties care for the poor in or through nongovernment free clinics. In lieu of pay, the state would protect the physicians from malpractice claims.
Competition among surgery centers and hospitals bring prices down and quality up. The inflated retail price for procedures and services would be a thing of the past. Please read about the experience of Keith Smith, MD, of the Surgery Center of Oklahoma.
Independent, direct-pay physician practices would also predominate to serve patient needs and wants. Prepaid or pay-per-office visits are options. Patients could prioritize which choice best suits their needs. They would be free to experience and learn from the risks and benefits of good health lifestyle habits versus risky behaviors. Josh Umbehr, MD, a family physician at AtlasMD in Wichita, Kansas, has a working model that produces both outstanding results and cost efficiencies that are not currently seen in our insurance- and government-driven model.
Tort reform, in the form of damage caps and health courts, work in states where instituted to decrease malpractice insurance costs and the costs of defensive medicine. Consider the example by Peter Leone, a malpractice insurance expert for more than two decades.
The main points of true free market health freedom:
- The patient-physician relationship must be sacrosanct and subordinate to no one—not insurance companies or government entities.
- Free markets work and create efficiency and cost effectiveness through competition for all parties—patients, physicians, hospitals, labs, insurance companies, etc.
- Patients get engaged when they must prioritize, choose options, and manage costs within their value systems.
- Health insurance must be scaled back and competitively priced to be major medical coverage that reimburses patients for major losses. It must be individual or group sponsored, but not employer sponsored.
- Individual choice and freedom must be vigilantly maintained for all parties.
- Tort, malpractice, and liability reform must be achieved to reduce costs for all parties via caps on non-economic damages and health courts.
- Physicians must be free to innovate and compete without government or insurance interference. Competition will create efficiencies to provide the best service and lowest price.
- Primary care physicians can coordinate care using analog or digital methods as they see fit, not by government mandates or insurance schemes.
- The Affordable Care Act must be repealed to allow real free market competition to bring efficiency and cost effectiveness to healthcare delivery, insurance administration, and patients’ lifestyle choices.