Dr. Edward Gray: A doctor’s perspective on healthcare
April 1, 2017
As a hospital pharmacist, a dentist, oral surgeon, and a physician who has done rotations with the Veterans Administration in this country, and with the National Health Program in England, I'm well situated to evaluate private medical care and single-payer programs and recognize their respective strengths and weaknesses. A complete analysis is beyond the scope of this column, but I can make several recommendations, and have made them in a letter to President Trump, select congressman and senators, that would significantly improve medical services in the USA today and replace Obamacare. I will outline them here.
First, control the lawyers. Fear of litigation increases the cost of every aspect of health care from diagnosis to treatment. Medical care is not without risks, but healthcare providers generally try to do the best they can, and the threat of large financial penalties for not working miracles only raises costs by adding continual second-guessing. Removing this burden would reduce patients' premium costs immediately. It would remove a huge financial burden on healthcare providers at all levels and remove a giant cloud hanging over the head of virtually everyone working in the healthcare field. Practicing defensive medicine, as we all do now, is expensive, time-consuming, and demoralizing. It works against the best interest of both doctors and patients.
Secondly, incentivize free care by giving tax deductions for providing it. At its core, the Affordable Care Act was about providing health care to the very poor. But access to insurance isn't the same as access to care, especially for poor families. As it is currently evolving, Obamacare is rapidly becoming a plan with no (or very few) in-network doctors, and no clinics that will see you. This is not access to care. That card in your wallet means nothing if no one will accept it. A $6,000 deductible is not access to care. Allow doctors, clinics, and hospitals to deduct the free care they give to poor patients. The goal of access to care for the poor would be solved with this one simple step, without the need for a huge government bureaucracy. Stories of patients unable to find health care would disappear. Signs reading "Medicaid not accepted here" would go away.
Third, allow U.S. health insurance to be sold nationwide and worldwide. The recommendation is often made insurance should be sold across state lines. But why stop there? In 2015 the U.S. had 450,000 medical tourists — that is, someone who comes here for healthcare they can't get in their home country. This is because the U.S. offers the most technologically advanced healthcare on the planet. Bureaucrats who understand accounting but not medical care think they can cut costs by reducing availability of specialists and the procedures they offer. We should be doing the opposite: increase the insurance pool by selling access to coverage world-wide. Increased numbers of buyers for insurance coverage means greater stability for the insurance industry. It means we, as a country build on our strengths, rather than tearing them down.
Finally, an effort needs to be made to change the disincentives currently built into regulations covering pre-existing conditions. But we need to address this rationally. Federal laws requiring insurance companies to accept pre-existing conditions result in incentives to offer lower quality plans. If you're uninsured, and get sick, you are going to sign up for a high cost plan that provides great coverage. Insurance companies will have to stop offering high cost, high coverage plans or risk bankruptcy. Americans who buy insurance will have poor choices, as those choices will provide only minimum coverage.
The private sector can find innovative answers to the problems we face if Congress would simply create a legal framework that allows America's entrepreneurial spirit and inventiveness to explore the possibilities unhindered by burdensome regulation and ill-conceived government control. Experience has taught us government isn't going to give us a solution that works.
They will give us a solution that requires lobbyists, campaign contributions, and new unions, all to keep the flow of money heading toward Washington. They will give us a system that allows lawyers to continue to treat doctors as lotto tickets.
The proposals above, which I outlined in greater detail in a letter to President Trump, grow out of a lifetime of working in healthcare in large and small, rural and urban, private and government institutions. They recognize the exceptional level of innovation in the American experience and our problem-solving nature. They also recognize the inability of the government to solve our problems. Obamacare is failing daily. Ryan Care, Obamacare light, will fail as well.
Government needs to get out of the way, stop meddling for money and power, and allow doctors, clinics and hospitals to take care of patients.
Dr. Edward Gray is a previous hospital pharmacist, dentist, medical physician and surgeon specializing in oral and maxillofacial surgery in the Carson Valley.