Dr. Brian Joondeph
With all the talk about defunding/repealing Obamacare, a missing component of this discussion is alternatives. A robust discussion is needed rather than simply “let’s get rid of it.” My submission provides such an alternative for consideration and discussion.
My background is 20+ years practice as a Denver-based retina surgeon, working both in private practice and academics, including several years in another country with nationalized health care. I have also recently completed a Master’s degree in Healthcare Leadership at the University of Denver, with much study of our current and alternative healthcare delivery systems.
A more detailed bio from my practice website.
Thank you for your consideration.
Repeal Obamacare? Then what?
Obamacare’s popularity is waning in public opinion polls. Republican lawmakers talk of defunding or repeal, despite the current political improbability with Democratic control of the Senate and White House. Pending the outcome of the 2014 elections, repeal may actually be an option. But what then? A return to the status quo of unsustainable healthcare spending may avoid the many problems with Obamacare, but is hardly a solution. Unless Republicans present a simple, easy to understand, and workable alternative, Obamacare may instead morph into a government-run single payer system as Senate Majority Leader Harry Reid recently predicted.
I propose an eight-step program, where the steps can be taken individually or better yet as a whole, as a “doable” alternative to Obamacare.
1. Move away from employer-based heath insurance, a relic of depression era wage and price controls, phasing out over five years. Similarly, phase out Medicare and Medicaid. Instead provide everyone with a $2000 tax credit or voucher toward the purchase of individual insurance. Everyone would own his or her insurance and keep it regardless of employment status. Let businesses run their “business” rather than spending energy looking for ways to circumvent expensive healthcare benefit mandates.
2. Require everyone to purchase, at a minimum, a $2000 deductible policy providing catastrophic and preventative services only, with subsidies to offset the deductible based on means testing. Remember that this is insurance and not prepaid healthcare. The “individual mandate” has been declared constitutional so despite misgivings about such mandates, they are indeed legal. Those without proof of insurance lose their tax credit. The ability to purchase a basic policy would not be affected by health status or preexisting conditions.
3. Basic coverage would be determined in a similar manner to the Oregon Medicaid program with all medical procedures ranked in order of “net benefit.” With input from physicians and the public, a line is drawn through the list based on available public funds; above the line covered and below the line not covered, by the basic benefit package. This reflects the reality that finite public funds cannot fund infinite demand for medical services. The ranking and cut off can be reviewed and changed each year with input from patients and providers.
4. Insurance companies are free to offer policies with greater benefits (and higher costs). An online tool would allow persons to design their policy, selecting particular benefits, copayments, and deductibles, to meet their needs, with the insurance companies offering policies to meet those needs, similar to the online purchase of travel services.
5. All licensed healthcare providers, as a condition of licensure, would be required to provide one week per year of free care, within their scope of practice, to the under or uninsured at a health center or through their own work facilities. Under any system, including Obamacare, many still slip through the cracks and are left uninsured.
6. Shift from a tort system to a no-fault single payment system for adverse events or complications, based on a predetermined fee schedule. This would reduce the costs of malpractice insurance and defensive medicine, and provide timely compensation to patients, avoiding lengthy malpractice litigation, appeals, and hefty fees to plaintiff lawyers.
7. Provide coverage for preventative care and annual physicals, regardless of the insurance deductible, based on evidence-based guidelines. Encourage medical research into the comparative effectiveness of various medical treatments, including preventative services. Cover treatments that provide true value.
8. Provide wellness incentives toward premium reductions based on smoking status, weight, fitness level, and other easy to measure criteria. Meeting and maintaining certain goals results in a lower premium or higher tax credit. Incentivize healthy behavior financially rather than punishing bad behavior – a carrot rather than a stick.
These eight steps represent an easy to understand framework for reforming a broken American healthcare system. These measures expand coverage to all citizens, allow individuals to purchase the insurance they want or need, encourage personal responsibility and healthy lifestyle choices, and acknowledge the reality that healthcare services are finite. As Herbert Stein observed, “If something cannot go on forever, it will stop.” If Obamacare cannot go on forever, will a reasonable alternative be offered, or will healthcare slide into a single payer government run system?
Brian C Joondeph, MD, MPS, FACS
Colorado Retina Associates, PC
8101 E Lowry Blvd, Suite 210
Denver, Colorado 80230-7193