Breaking news from Washington:
House of Representatives Republican leaders ripped the Affordable Care Act, known as Obamacare, and Majority Whip Kevin McCarthy, R-Calif., urged a “patient-driven health care system, not a government-driven health care system.”
So, House Speaker John Boehner, R-Ohio, was asked at a news conference, what does that mean?
“Well,” he said, “When you look at “Obamacare,” what you see is a government-centered health care delivery system. That’s not what the American people want.
“The American people want to be able to pick their own type of health insurance; they want to be able to pick their own doctor; they want to be able to pick their own hospital. That’s what a patient-centered health care system looks like.”
Asked if that was likely to come to a vote next year, Boehner said, “We’ll see.”
Finally, no more in-network-out-of-network! No more we-don’t-accept-Blue-Cross-Medicare-or-Medicaid! No more United-Healthcare-is-no-longer-offered-by-your-company! No more if-I-get-this-job-I’ll-get-health-insurance! No more reasonable-and-customary-charges!
The American people will be able to choose whatever doctor they want and any kind of health care insurance they want. It won’t matter if you’re homeless, you’ll be able to go to the best doctors on Park Avenue. If you stock shelves at Walmart, you’ll be able to get high-quality care at the Mayo Clinic. If your company offers health insurance plans A, B and C, you’ll be able to choose D.
It won’t make any difference to anyone how much doctors, hospitals or insurance companies charge, because the Republicans now have a plan, the ideal plan that nobody else had the courage or insight to propose. In retrospect, however, it’s clearly the only way to guarantee everyone’s right to whatever health care they want without interfering with the free market:
Every American citizen will have an unlimited supply of money to spend on healthcare! It’s the MONEY IS NO OBJECT plan! (MINO, for short.)
It’s the perfect “conservative” free-market solution, since everything for sale in the healthcare marketplace will be as good as free for consumers, while providers will retain the right to make as much money as possible.
(Note: Aside from replacing the words “government-centered” with “patient-centered”, details of the plan are, to be polite, “sketchy”.)
Meanwhile, here on Earth, there is an informative article in a recent New York Review of Books called “Obamacare: How It Should Be Fixed”. It’s by Arnold Relman, Professor Emeritus at Harvard Medical School. Unfortunately, you have to pay to read the whole thing (after MINO is in effect, we’ll all be able to afford it). But Dr. Relman concludes that our best hope of getting a high-quality, affordable health care system would be a single-payer system built on Accountable Care Organizations, i.e. private medical groups that would be paid by the government, not for every service performed, but for their patients’ overall care:
The only type of ACO [Affordable Care Organization] that has been proven to satisfy patients and physicians is multispecialty group practice. According to the American Medical Group Association, there are now well over 430 such group practices and their number is increasing rapidly as more physicians seek group employment….
Data from the Medical Group Management Association indicate that average staff earnings in groups are fully competitive with earnings in solo or small partnership practice, particularly if the generous fringe benefits that groups usually offer are also considered (for example, office expenses, malpractice insurance, paid vacation, pension plans). And judging from their low turnover rate, physicians who choose employment in successful, well-managed groups are usually satisfied with their job.
However, only a few medical groups currently avoid the inflationary incentives of fee-for-service by contracting with insurance plans that pay them on a per capita basis for comprehensive care of some or all of their patients; and even fewer pay their medical staff by salary….
… I have described in detail how a single-payer system sponsored by the federal government would function when coupled with a reorganized medical care system based on independent multispecialty group practices with salaried physicians. Replacement of all public and private insurance and elimination of itemized bills with a public tax-funded system that simply paid medical groups per capita for comprehensive care would avoid much of the expense and many of the other problems with the current system. The enormous savings could ensure adequate compensation for all the facilities and physicians needed for universal care.
The loss of jobs in the eliminated private insurance industry would probably be more than compensated by increased employment in a greatly expanded public-payer system, and by the new jobs created by the emerging business opportunities created when employers no longer need to pay the health costs of their employees. Government would be able to contain the rise in total health expenditures by its power to set prices and determine the level of taxation required to fund the system, but it need not micromanage medical care. Medical decisions should remain in the hands of physicians and their patients, where they belong.
Most important, this revolution in our health care system would make universal access to good care affordable. It is a revolution that seems inevitable, even though it is not yet on the political horizon.
I’d say it’s far, far beyond the horizon, but at least it’s on planet Earth. Meanwhile, we’ve got the ACA, which is significantly better than what we’ve had.