Whether we like it or not, Obamacare is the law of the land. Moreover, no one can argue that it has fundamentally changed the American healthcare system. We have been distracted by the disastrous roll out. Unfortunately, while we were distracted by constant bickering, the government has inserted itself between the doctor and the patient and taken control of the system – from a doctor’s treatment options to a patient’s choice from cradle to grave, and everything in between.
The debate on whether to repeal, amend or let the process continue to its conclusion has devolved into a heated argument where it is all about winning at any cost. But while pundits and politicians are preoccupied with winning, people are dying, people are losing their financial underpinning, and there is both a transfer of health and a transfer of wealth. In short, the healthcare system is breaking into a two-tiered system – those who are relegated to Obamacare will be trapped in a system which locks them out of the very best healthcare that our country has to offer while those who can afford to will simply opt-out.
The current belief that everything will be rosy if everyone has health insurance is fundamentally flawed because having health insurance does NOT equal having access to affordable quality healthcare. The players involved with crafting Obamacare such as the pharmaceutical industry, the medical insurance industry, and the hospitals helped to craft a law that doubles down on the worst aspects of the health insurance problem. This explains why 30 million people will remain uninsured even if Obamcare is ever fully implemented.
The mantra of ever increasing healthcare costs caused by unscrupulous doctors has been dinned into our collective consciousness without regard to facts. The truth is care given by an independent private physician is the most cost effective type of healthcare received. If the independent private physician and the patient had been given a seat at the table, they would both have provided a powerful voice to distill the problems and provide solutions. After all who knows better about what is broken in a system than those on the front line who have to advocate for their patient while doing what it takes to make payroll, and those who want to find the best and most cost effective health care respectively.
Academic solutions to health care such as buying health insurance across state lines and keeping children on their parents health insurance until age 26 are great talking points, Unfortunately, they ignore the reality that there is still no cap on what an insurance company can charge the patient in out of pocket expenses; they can still deny coverage after a medical service is rendered; and they can still deny needed medical care on the basis of what they decide is medically necessary or what care will be allowed because they consider it experimental without regard to what the physician finds is medically indicated.
Instead of starting with the doctor patient relationship as the core of what it takes to provide efficient, excellent individualized cost effective healthcare, the middleman has been empowered driving bureaucratic layers with regulations and committees that inevitably increase cost. That cost is borne by the patient in longer waiting time, rationed care, and replacement of their trusted physician with less experienced extender providers such as physician assistants and nurse practitioners. There has even been a movement towards expanding the scope of practice by allowing pharmacists to write prescriptions and nurse practitioners and physician assistants to perform certain surgical procedures in the name of providing access and cutting costs. However, there is no way to calculate the cost that a patient may pay with a missed diagnosis or a botched procedure in the one size fits all conveyor belt driven medical system that is being set up.
The two tier system that is being created under the auspices of Obamacare can be broken by following the alternate path of free market medicine which is alive and well and thriving. By removing the insurance company and government middlemen, a patient will find that their costs will drop precipitously. They will once again have their choice of doctor, have the procedures they want, have a quality relationship with their doctor who will be able to spend time with them, and know what their costs are up front. The options are myriad and include:
- Urgent care centers staffed by board certified ER physicians that charge a flat fee for visits that include x-rays, blood work in addition to the consultation (eg., North Atlanta Urgent Care http://www.atlantaurgentcare.com/)
- Surgery centers who list their prices such as the Surgery Center of Oklahoma (http://www.surgerycenterok.com/pricing/)
- Websites where you can bid for medical services (www.medibid.com)
- Doctors who barter and have a sliding fee scale (www.aapsonline.org)
- Medical Cost sharing organizations (www.libertyoncall.org) which are allowed under Obamacare guidelines. For example, Liberty health share will pay for 100% of health care costs (no eye or dental) after a $500 dollar deductible are met, for $199 dollars per month for an individual with a maximum coverage of 1 million dollar per occurrence per year. Unlike an insurance plan which has in network panels, resources are pooled and costs are shared so members can see any doctor or go to any hospital they want since the company pays for the medical services for a self pay negotiated rate.
- Supplemental plans offered by as AFLAC actually pay patients after they have medical services such as surgical procedures or treatment for cancer.
- A website which is a one stop shop for information for those who want to explore the free market medical system (www.theselfpaypatient.com).
Each of these strategies provide an option that will give the patient true control of their health care dollar to spend in a system where there is true competition that is driven by innovation, customer service, collegiality and personal responsibility on the one hand instead of cronyism, control and coercion on the other.