Solutions for our healthcare system

March 9, 2008

For our follow-up to our initial open letter to America, we must continue with our patient focused concerns. We must also show that we can make changes to the present system that will increase affordable access to care for all, and cost our government less. It will also keep the present industries in business, but would necessitate a change in the way they do their business. We are the workforce in healthcare. We have the power to induce change if we remain united in our goals. This followup letter must show our continued unity with a focus on improving our healthcare system for all.

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We the Physicians of the United States of America, have taken an oath to serve the medical needs of you our patients. As written in our previous letter, the present system makes it more and more difficult. It is wasting billions of dollars a year, increases patient and doctor dissatisfaction, and ruins the needed trust in the doctor patient relationship.

It is time for a change. It is time our healthcare system returned to the principles of our founding fathers, of individual responsibility, where medical decisions are made solely by you and your doctor.

Here are my proposals:

Medicare:

Freeze spending at 2008 levels- this will help our federal government keep costs down and allow Medicare to continue for future generations, while taking up less of our nations GDP.

• Allow doctors to balance bill patients above Medicare set rates. This allows doctors to keep up with their ever increasing overhead. This also allows doctors to remain open to treating Medicare patients. It also opens up Medicare to free market principles, which invariably will keep fees low and quality high.
• Allow secondary medicare insurances to pay more than Medicare if fees rise. These secondary insurers can compete in the free market, which they are very good at.
• End Medicare Advantage plans and the overregulation it causes.
• Means-test Medicare deductibles according to patients tax filings. Higher deductibles for wealthier patients, lower for poorer.
• Make preventative medical care for medicare recipients tax deductible.

Other Third Party Insurances:

• End Third party insurance meddling and determination of care. This third party intrusion into medical care has done the opposite of its intentions while producing profits in the billions. These profits drain the system of much needed resources for medical care. The profits based on ever increasing premiums have made health insurance so unaffordable to many, i.e. 47 million uninsured.
• End Insurance networks and give patients true choice in picking their doctors.
• End Referrals, preauthorizations, pre-certifications, etc.
• End insurance formularies, PBM’s which only serve to restrict and deny medications and increase profits for an unnecessary middleman.
• Stop P4P before it starts.
• Let the market decide the prices- lower cost alternatives will flourish!

End government mandates:

• all people should have equal access to care, but not all people need the same care. Equal care for all means mediocre care for all. One size does not fit all.
• Government should set up system of fair rules and then stay out of it. These rules should be enforced to go after the 1% of doctors, patients, and insurance companies breaking the rules, but leave the other 99% alone.
• Increase individual responsibility.
• Make healthcare insurance and payments tax deductible for individuals as well as employers. Employers should not be mandated to buy insurance for employees. But employers can compete for employees by joining co-ops for health insurance to allow their employees to purchase insurance policies based on individual needs. These policies become portable and individually owned regardless of employment status.

Increase availability of CDA’s and HSA’s.

• This increases individual responsibility while decreasing entitlement attitude towards healthcare. It may even encourage health savings for the future.
• Eliminate bankruptcies that allow discharge of medical debt. This increases individual responsibility and decreases use of our overcrowded emergency rooms. Primary care offices can provide cost effective care for non-emergent conditions.
• End lobbyists power over medical care and decision making. Medical decisions need to be made by doctors-patients PERIOD, and guided by free market principles.

Tort Reform: Defensive medicine cost billions. My local yellow pages has over 130 pages of lawyer ads, and under 40 pages of physician ads. Why the discrepancy?

• The present system allows for jackpot verdicts and is not sustainable. It is driving doctors out of business and into early retirement. A proper system is fair to all and does not increase the cost to all, for the benefit of the few who get jackpot verdicts.
• Propose a medical courts system where we are judged by our peers and not by public sentiment. This will allow for proper damages. It will also force change in the system to deal with medical errors as they occur. The present system does not.

Big Pharma: Your public perception is at the lowest it has ever been, and your stock prices are following. You need to change the way you do business. The free market will help your industry immensely. But todays back door deals with insurance companies and the medication-formulary system does not work for the greater good of our nation. For people without insurance to pay inflated costs to make up for the lower cost to insured patients does not work and is not fair. The system needs to have a level playing field.

• Immediately end DTC advertising.
• Have full transparency in medical studies. Publish all studies, not just those that support your products. No more manipulation of data. If you do, you will be called to task on it! You do not want a continuation of the Vioxx lawsuits.
• Stop dealing with third parties for pricing.
• End pharmaceutical formularies.
• With the cost savings, lower your prices to make your products affordable to all.
  
  
  These are just my thoughts as a solo family physician. I am open to any and all options that we can add or subtract. But we need to focus on one common goal. What is best for our patients and sustainable for our nation.
  
  Steven Horvitz, D.O.
  Founder Institute for Medical Wellness