The BRI Blog

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Debate: Does the Affordable Care Act help or hurt doctors and their patients?

10/27/2016 at Marian University College of Osteopathic Medicine

• Dr. Beth Haynes, Executive Director BRI
• Dr. Timothy Von Fange, St. Vincent Sports Performance
• Dr. Robert Stone, Hoosiers for A Commonsense Health Plan (PNHP)
• Dr. Meg Gaffney, Indiana University School of Medicine Associate Professor and Dermatologist
• Dr. Jason Eberl, MUCOM Chapter BRI Faculty Advisor and Chair of Medical Ethics at MUCOM

Five questions were asked to all the debaters with 2 minutes to respond to each question, followed by 1 minute to rebut any responses. The debaters all spoke with passion and a profound knowledge on the topics involved in the questions.

Some of the questions:

• What, if any, limitations are placed on patients and physicians due to the Affordable Care Act (ACA)?
• Many individuals complain about the mandate to carry health insurance, even though they qualify for cheaper ACA plans.
• What political, social, or economic values are coming into conflict here?
• What changes would you make to the ACA, or what alternative system would you propose?
• What would be the benefits or potential weaknesses of these changes of the new system you’d propose?
• With the presidential election coming up in less than two weeks, is there a candidate that you believe has a better healthcare plan than the other candidates? (Hilary Clinton, Donald Trump, Gary Johnson, Jill Stein).

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There’s more to economics than just the Austrian and Chicago schools of thought. When it comes to healthcare policy, sometimes free market vs. government-centric proposals have more sway than either theoretical economic approach. Economics and political policy (in this case healthcare policy, which has become highly politicized) are closely intertwined, however; so, the more both doctors and patients understand the likely results of free market and government control options, the better healthcare choices they can make.

More by Trenton Schmale

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Understanding healthcare policy and healthcare economics theory has become important even for doctors to practice medicine. Andrew Widener, medical student from The University of Texas McGovern Medical School addresses the economics of healthcare from an Austrian economics perspective. By understanding underlying economic principles, doctors will be better equipped to foresee and engage with both the positive and negative outcomes of healthcare policy.

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Alicia Seggelink, BRI chapter leader from Rosalind Franklin University Medical School discusses how to create an effective communications strategy. While aimed at helping BRI chapters be successful, this tool can be used for almost any organization.

Alicia was recently selected to be the Medical Student Section (MSS) representative to the Council on Communications for the Illinois State Medical Society (ISMS). According to Alicia, her quest for that position came directly from her experiences at BRI’s recent 4th Annual Leadership Conference in Washington, DC.

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Mary Hahn, from SUNY Downstate Medical School, experienced a bumpy ride establishing a BRI chapter at her school. In spite of a few setbacks — not the least of which was the campus environment not entirely welcoming of free market ideas — Mary persevered, and not only established a successful BRI chapter, she also provided a place for other like-minded medical students to be able to participate in a conversation for free market healthcare.

The Blog post was written by a BRI Student Leader who wishes to remain anonymous.

Part I
Part II

… And now for some basic questions about a cash based healthcare system, since we’ve put the philanthropic and economic questions to rest…

I’ve heard some conservatives advocating for more cash-based medical care. The insurance plan I have now is expensive, but it covers most of my healthcare needs. 

To understand the state of healthcare in America today, it is useful to understand the historical background in which our system developed. Our tradition of employer-sponsored health insurance arose during the 1940s in response to a government-imposed freeze on salaries. In order to supplement employees’ income, companies began offering health insurance benefits. When the wage freezes were repealed, employer-sponsored insurance did not go away with them. Americans became accustomed to employer-sponsored insurance, and being covered by a comprehensive health insurance plan became the norm. Unfortunately, this has led us into a state of over-insurance: Americans are paying excessive amounts of money for healthcare benefits that they previously purchased directly through cash payments.

Insurance is a tool to hedge against unexpected misfortunes, like your house burning down or a natural disaster. It is not meant to be used for routine expenses like paying your electric bill or buying groceries. However, Americans now buy health insurance that includes a spectrum of both routine and catastrophic medical care. When proponents of free enterprise talk about cash-based systems, they are advocating that we shift back to a system in which consumers pay for routine medical costs out of their own pocket. The point of this is to align consumers’ incentives so they are naturally drawn to make the most efficient economic decisions. If you are responsible for paying for your routine healthcare, you will be inclined to search for the services that fit your preferences, and you will be hesitant to consume services that are unnecessary. It is easy to spend someone else’s money, but people spend much more deliberately when it is their money in question. The only “single-payer” for routine care should be individual patients themselves.

What are the benefits of moving to a cash based healthcare system?

If we shift back to a cash-based system for routine medical expenses, health insurance still has an essential role to play. Health insurance will still be essential to insure against unexpected, catastrophic medical events. The price of this insurance should be reasonable because it would only cover medical events over a certain dollar amount; all of the routine care that is inflating health plan pricing today would be excluded from catastrophic insurance.

A system based on mixed cash payments and catastrophic insurance would be extremely beneficial for patients and their doctors. Cash payments for routine care would vastly simplify the insurance payments fiasco that doctors experience today, reduce administrative costs, and allow physicians to spend less time filling out paperwork and more time with their patients. Physicians and patients around the country are beginning to embrace this system, and early results show that the cost of care is decreasing, health outcomes are stronger, and physician satisfaction with their work is much higher. A few examples of successful cash based practices include the Surgical Center of Oklahoma, Atlas MD, and Gold Direct Care.

Although this concludes our series on free market medicine point/counterpoint, I hope it is just the beginning of the dialogue on how we can work together to transform American healthcare. Do not hesitate to share your beliefs with your peers, despite what they might believe currently. Dynamic social change occurs because small groups of people are willing to speak for what they believe, even if it is unpopular.

This is our time.