Fund the Money Pit or Move to Sustainable Patient-Centered Care: Rethinking Health Care Policy
The Affordable Care Act was passed ten years ago. Within that time, the name itself has become oxymoronic. In the ACA individual market insurance exchanges, single coverage premiums (unsubsidized) increased by 62% and family coverage premiums increased by 75% just since implementation of ObamaCare! From 2007 – 2017 the average premium for family coverage in the Group market increased by 55% while median household income went up by only 3%. The administrative and regulatory costs of Obamacare clearly surpass the benefit to citizens.
So why is Joe Biden proposing to shovel $750 billion into the pit to shore up this failed program? Like many politicians and bureaucrats who have confused coverage with access to real care, Biden believes more funding will make our health care woes disappear. A central theme of Biden’s health care reform plan - let’s call it O’Bidencare - builds on the Affordable Care Act and would remove income limits on health insurance subsidies. This would give everyone access to a government subsidized “public option” known as Bidencare.
But, unlike a tax credit approach to a market-driven option, Biden’s version of the public option would result in crowding out of private insurers who could never compete with an unending flow of tax-payer subsidies. Some say that private insurance companies would go out of business altogether because they would no longer be able to compete. Biden’s option would eventually be our only option - leaving our health care at the mercy of the government’s central planners.
And public options offer no clear advantages over private coverage when the playing field is level. For a Public option to be superior, it requires the system to be rigged by politicians, mandating participation by providers and requiring them to accept lower fees.
Despite proposals from Biden to double-down on the current dysfunction, the Republicans have not coalesced around one plan, though many market-friendly reforms have been floated. Given the obvious fatal flaws of the Affordable Care Act and lack of political will to confront the real cost-drivers, many have lost faith in a government solution for a problem that government largely caused.
Fortunately, the private sector has brought forward new ideas for health care reforms, and these promise access to affordable and innovative care on our terms. Alternative market-driven options exist that improve access, reduce costs, and move patients into closer relationships with their doctors instead of with government bureaucracies.
One of these solutions is Direct Primary Care, or DPC, allows patients to access a primary care physician for a monthly fee roughly equivalent to a cell phone bill. DPC practices do not bill insurance, nor require any specific kind of insurance to become a patient. The model’s practitioners typically outline extra costs transparently, so patients know exactly how much they owe and what they are getting for their money. A study issued in 2020 by the Society of Actuaries shows that nearly 40% of patients who use this care model can avoid costly trips to the emergency room. Patients at DPC offices also get more time with their doctor -- an average of 38 minutes per visit, as opposed to the traditionally insured patient’s average of 17 minutes. Due to the flexibility of DPC practices, including appointment-by-text and same-day appointments, doctors can develop personal relationships with their patients, enabling a better experience for everyone involved.
Giving patients more choice and freedom is central to any good or potentially successful reform plan. One such plan, developed by Dean Clancy and known as the “personal option,” has the central objective to expand Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs) so patients can choose their own health care and finance it with a monthly tax-free allowance from their employer. Any remaining out-of-pocket costs would also be tax free. This plan especially benefits younger workers, who are more likely to change jobs and lose their insurance coverage in the interim. And, creates a health care market where patients have leverage and the incentive to spend their money efficiently.
Unlike Biden’s public option money pit, good alternative solutions return choices and decision-making back to the patient. They allow competition based on price and quality instead of government interference and eliminate useless, and sometimes harmful, regulations. Americans do not have to sacrifice quality for affordability; health care can be accessible and affordable. There is no need to spend $750 billion on a failed program when the free market gets the job done.
Dr. Bob Nelson has been a primary care and urgent care doctor for more 25 years. He is also the Publisher of the Forum for Health care Freedom, a blog and information resource tool dedicated to Promoting Freedom in Health care Using the Power of honest pricing & Free-markets.
