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BLOG: Fixing the Affordable Care Act
After years of bluster and posturing, the Republican members of Congress are finding that “repealing and replacing Obamacare” is not quite as easy as talking about it.
There are a number of inherent conflicts in the very concept of a free market health care system that only some type of compromise will be able to solve. Too many of our elected representatives view the related issues as black and white and have been unwilling to look at innovative ways to improve the current law.
Some of the conflicts of a free market health care system are: Our citizens want comprehensive health care but either do not want or cannot afford to pay for it; our culture has evolved around an insurance-based system that focuses on the management and treatment of medical problems rather than health education and prevention of disease and injury; too many of our citizens view healthcare as a commodity that should be purchased by each individual when needed.
To organize an effective free market health care system, there must be certain basic elements of the system that are universal and certain elements that can be purchased to build to as much comprehensive coverage as desired by those who can afford it.
The crafting of the system to allow for both basic health care rights for all citizens and free market options is the role of the Federal government as designated in the Constitution with the phrase in the Preamble that states: “promote the general Welfare.” Like safe roads and clean water, basic health care is required for any modern society.
There are two sides of the equation that need to be balanced to fix the current law.
The fight about whether to amend the current law or repeal and replace is political nonsense and amounts to the same thing.
The first side of the equation is the funding of the universal coverage. This needs to be done with a tax system that provides incentives for health and wellness and penalties for high risk or unhealthy choices.
Like the tobacco tax and the sugar tax, taxes can be established on other unhealthy foods and beverages as well the purchase and participation in high-risk activities such as motorcycles, jet skis, parachutes and fast cars. We could also create a health care tax as part of the penalty for speeding, texting while driving, impaired driving or any other activity that jeopardizes public health and safety. This type of tax system would allow our citizens the freedoms to exercise these activities while providing the funds to offset the risk related to the health care required to cover the consequences of these choices and activities.
Just as the system provides for financial penalties, there can be rewards for healthy choices and activities. The popular trend of fitness trackers can be expanded to encourage people to learn how to use these devices and wear them with tax credits for hitting their milestones. Likewise, the purchase of kale rather than potato chips can earn you a tax advantage. We have the technology to track these activities why not use them to improve our nation’s health?
On the other side of the equation is the delivery of care.
The first task is to redesign the base coverage or essential elements of the universal package. The current program is too broad. The essential elements need to cover two basic components; primary care (health education, wellness and prevention) and catastrophic care (hospitalization and essential surgery).
The middle ground, doctor visits to treat diagnosed acute medical problems and all the care related to chronic illness can be premium-based and as comprehensive as desired. This is an exact reversal of the current insurance-based system.
The primary care piece needs to be the critical component of the basic system, as it will lead to a healthier society and to lower long-term costs.
The care delivery model of this type of care needs to be dramatically modified to achieve this goal. The current narrow, primary care physician based program cannot effectively deliver this care. Even with the medical home model and the aggressive use of physician assistants and nurse practitioners, it is not nearly enough resources.
The system needs to empower the ever-growing army of other health care practitioners to be directly involved and responsible for the basic primary care services. This list includes the obvious cast of the licensed health care providers: optometrists, dentists, podiatrists, pharmacists, and chiropractors. In addition, it needs to include nontraditional resources such as: mental health providers, physical therapists, occupational therapies, athletic trainers and any other providers that interact with the public in some aspect of health education, wellness and prevention.
The final piece of the puzzle is again the use of current technology to provide health education and advice. This is the ever popular “Dr. Goggle”. Perhaps short of Dr. Oz or Dr. Phil, this is the most popular and widely used doctor in America. This provider needs to be vetted and credentialed and become an official source of legitimate medical care.
This blog represents several substantive, yet “out of the box” concepts and ideas that need to be part of the thinking process to take the next steps in health care reform.
Clearly, optometry is part of the answer as noted, but we need to be a part of a sweeping change in the current system.
As seasoned primary health care providers, and part of the current package of essential benefits, we need to be part of the process.
It is these types of ideas that we need to share with our elected officials rather than our opinion on the current polarizing issues of the day.