Two  Health Care Alternatives

What’s the alternative?  That’s the perpetual question asked when faced with difficult questions.

After writing over 4000 blogs and six books on health reform over the last 10 years,  I have come to the following conclusion.

There are two alternatives.  Why don’t we stick with both? Progressives could keep their piece of the health care cake, while conservatives could retain their slice.

·         Top-Down Government-Driven  Care

One is top-down government care as exemplified in Medicare and Medicaid.    These two programs now cover 125 million Americans (55 million in Medicare, and 70 million in Medicaid), and they are certain to grow as our population ages and if our economic growth remains stagnant.   I would  not include the PPACA (Patient Protection and Affordability Care Act), or ObamaCare,  in this alternative, because it has neither protected the majority of Americans nor made their care more affordable.   The PPACA, however,  has lowered the uninsured rate to 9.1%. That’s  a good thing.   Medicare and Medicaid has done well  for  the old and low-income  income patients,  have been established for 50 years, and are politically popular  and impossible to end.  Let’s keep them largely intact. My only suggestion for maintaining their sustainability  is that we edge up entry into Medicare by 2 years or so, and hand over Medicaid management to the states, each  of which has a unique set of problems. 

·         Bottom-Up  Market-Driven Care

Here  I suggest a new program. We could call it  FMCACA (Free Market Choice and Affordability Care Act).    It is based on the philosophy of Milton Friedman (1912-2006), who explained, “So that the record of history is absolutely clear.  That there is no alternative way, so far discovered, of improving the lot of ordinary people that can hold a candle  to the productive activities that are unleashed in a free enterprise society.”   This Act would free people to choose what manner of care they desire.   It would consist of these components:  larger risk pools to help lower premiums,  freedom of choice of doctors and health plans, health savings accounts expansion,  universal health care tax credits, portability of plans across states, state flexibility in managing Medicaid populations,  tort reform to lower malpractice expenses,  and less bureaucratic intervention into doctor-patient relationships.    This act would  stand in contrast to top-down government elitist  policies, which advocate,  fixed global payment rates,   control of population health through data monitoring,   alternatives to fee-for-service payments, competitive bidding for all services, centrally controlled, health  exchanges,  one size-fits-all administrative structures for all providers,  full transparency of prices, more care by non-physicians, banning of physician self-referrals,  reducing costs of defensive medicine.     These policies would continue to apply to the Medicare and Medicaid populations.  Unfortunately,  the policies would accelerate physician shortages and limit patient choices and freedoms.

Conclusion

Given these two alternatives, which they will pursue anyway,  Americans should be free to partake in the  most affordable and convenient care, whether that care be centrally planned or  market-driven.