Wednesday, April 1, 2015

ObamaCare Replacement: You Don’t Beat Something with Nothing

I have a friend, David Coombes, a former hospital administrator and health care innovator, who helped me organize a series of bundled bills for a community hospital to supplement traditional fee-for-service care. Our plan was actually a blend of discounts for F.F.S. hospital and doctor fees backed by re- insurance should the bundled bill be exceeded. When anyone objected to the process, David would say, “You don’t beat something with nothing.”

Such is the case with ObamaCare. You can’t replace ObamaCare with nothing. There is no going back to the old ways of doing something.

You need a replacement program that lowers costs, expands choice, fosters competition, increases quality, provides a safety net, and protects consumers.

It must be a national program that makes sense , is understandable, and makes sense to the majority of voters in the upcoming 2016 presidential and Congressional elections.

And somehow the replacement must address current adverse physician trends. Among these are: decline in private practice with physician shortages, rise in patient costs in hospital-acquired practices, narrowing of physician networks, non-acceptance of health-exchange patients by 25% of physicians, growing numbers of physicians not accepting Medicare or Medicaid recipients.

As a result of federal mandates to meet information technology demands, ICD-coding requirements, and utilization regulations, more and more physicians are switching to direct care and cash practices, further exacerbating physician shortage problems.

The America people are restless with various elements of the current system – complexities of the health exchanges, mounting premiums and deductibles, scarcity of physicians, shifts of costs from employers to employees, and so forth. These elements are driving out-of-hospital care, urgent care clinics, retail clinics, telemedicine, innovative business models , and concierge medicine and ambulatory surgical practices.

In response to all of this, Republican candidates for president are presenting a mix of substitutes for ObamaCare - shopping across state lines, more health savings accounts, refundable tax credits for all, repeal of all mandates, state block grants for Medicaid, setting up high risk pools for individuals and small groups, creating more catastrophic coverage, dropping bail out programs for insurers. (Michael Tanner, “Replacing ObamaCare: Repeal Isn’t Enough. Republicans Need to be Ready with Alternative Plans, National Review, April 1, 2015).

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