It is obvious that our healthcare system is not working and fundamental changes have to be made. It is time to redefine what quality healthcare means. Instead of being considered a right perhaps it is time to think of it as a service. Patients are consumers seeking service that is accessible, affordable and innovative from a physician or medical facility that treats them as an informed consumer who should be respected and valued.

The Affordable Care Act was never about healthcare it was about control. The law was passed in 2010 using a slick campaign of promises that were never meant to be kept including the now familiar tag lines of ‘ if you like your doctor you can keep your doctor’ and ‘affordable health insurance for both uninsured and those uninsurable because of pre-existing health conditions’. In reality, it was a complex mix of taxes that effectively orchestrated a transfer of wealth from the working and middle class to the government in the form of taxes, and to the medical corporate complex (health insurance, Big Pharma and corporate hospitals) in the form of give away in the guise of mandates and corporate welfare.

The ACA is a house of cards that has been sustained by the tried and true method of divide and conquer by separating people into aggrieved interest groups and creating a frame work that creates straw men who can be vilified so that in essence nothing changes because people are driven by anger to look for someone to blame as the cause of the problem instead of creating a foundation that allows people to come together for the common good.

After seven years of Obamacare questions remain. If we are on the right track then:

Why is the US healthcare system still the most expensive healthcare system in the world yet continues to rank last compared to other western countries?

http://articles.mercola.com/sites/articles/archive/2014/07/02/us-health-care-system-ranking.aspx.

Why do Americans continue to pay more for prescription medication then everyone else?

https://mic.com/articles/125688/here-s-how-much-more-the-us-spends-on-medicine-than-everyone-else-in-6-charts#.FzfujXJKE

Why does the US have the highest first day infant mortality rate in the industrialized world?

http://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-reports/

If the goal is to fix our health care system. It is time to be honest. The healthcare system MUST begin to focus on the doctor patient relationship. If that remains fractured then everything that we want to do to build a viable, affordable, efficient and functional healthcare system will fail.

The Challenge:

The major problem with Obamacare was the presumption that having health insurance equals access to quality healthcare – it does not.

The structure of our health insurance model is based on inflated charges. It should not cost a patient 10-15 times more to have the same service performed in a hospital or satellite facility owned by a hospital compared to an independent free standing facility or independent physician’s office.

The Alternative:

The costs of healthcare will never be able to be controlled until the true costs are made transparent. It is past time for all medical services to be listed so that patients can become healthcare consumers. When patients are given the power to decide how much they want to spend for medical services that will encourage free market competition which will exert a downward pressure on cost. This is already happening within independent physician practices (direct primary care DPC practices, cash pay practices and surgery centers where patients can save 50-80% compared to services offered by hospitals, hospital owned physician practices, surgery centers, radiology centers and labs.

The Challenge:

The Obamacare subsidies to pay for premiums have done nothing to lower the out of pocket costs for patients. In fact deductibles and co-insurance have continued to rise. This has led to self-rationing by patients. They simply forgo procedures, stop taking medications and put off going to see the doctor because they can’t afford it.

The Alternative:

The Current administration made a positive step by getting rid of the mandate and the fines forcing people to pay for a product they can’t afford. However, the new changes do not address the problems of access to physicians (narrow physician networks) or high out of pocket costs in the form of deductibles and co-insurance. In addition, the inability of Congress to offer alternatives is creating unnecessary anxiety.

One of the fastest ways to lower costs would be to change the mix of the risk pools by changing the rule for keeping kids on their parents insurance until age 26. Lowering the age to 23 is a compromise that would give insurance companies access to a younger and healthier patient pool that could lower premiums for everyone

Catastrophic coverage plans would encourage younger and healthier people to purchase insurance instead of going without.

The alternative to the centralized one size fits all big government approach would be to allow for choice. On the one hand for those who like Obamacare allow them to keep it by expanding Medicare and Medicaid. For those who don’t want it, allow them the freedom to choose medical cost sharing, a non-insurance alternative; health savings accounts (HSAs) that can be unhooked from insurance companies so that patients can use their money for whatever medical care they want to use it for – commercial insurance, cash paying/DPC practices, alternative medical care, medical cost sharing, medical tourism or telemedicine.

The best way to lower costs is for patients to become healthcare consumers to have direct control of both their pocket book and healthcare choices. True value, innovation, and cost control will happen when patients are free to determine what works best for them.