The Blog post was written by a BRI Student Leader who wishes to remain anonymous.
These questions naturally follow the first (mistaken, in my view) assumptions in Part I of this series—first, that we have a completely, or mostly, free market healthcare system, and second, that doctors should be more altruistic perhaps than other service providers.
I believe all people deserve access to high quality healthcare services regardless of their ability to pay. What will happen to the poor and disadvantaged in a free market system?
A system that encourages transparency, empowers individuals to make efficient economic decisions, and removes class barriers, offers the poor the best opportunity to receive high quality healthcare. Considering the needs of the poor is essential when advocating for healthcare reform. The social paradigm that The Right loves markets and hates the poor is not only political invective, but completely false. Conservatives and libertarians appreciate free enterprise as the single most important factor in lifting billions of people out of poverty in the last century. Free enterprise is the greatest driver of wealth creation in the history of mankind. Admittedly, The Right often comes across as out-of-touch with the needs of the poor because our dialogue focuses too much on policy and too little on compassion.
Despite conservatives’ ineffective narrative, I submit that free enterprise offers the poor their best chance to receive high quality healthcare. However much we hope to improve healthcare, there will always be individuals who cannot afford to pay for their own care. Medicaid—government healthcare for the poor—still has a role to play in providing the means to care for these people. Today, Medicaid patients are often viewed as less desirable by physicians and hospitals because Medicaid reimbursement rates are substantially lower than private insurance, not to mention the paperwork and bureaucracy involved. This produces two possible outcomes, both of which are bad for the poor: 1) a selection bias that makes it difficult for them to find a physician, and 2) a care bias that sometimes leads them to receive inferior care compared to a privately insured patient. Both of these outcomes are unacceptable but expected results of the system that we have right now. Medicaid itself has led to the formation of a de facto caste system in terms of access to care and payments.
“Despite conservatives’ ineffective narrative, I submit that free enterprise offers the poor their best chance to receive high quality healthcare.”
Feasible solutions exist to simultaneously address the healthcare needs of the poor and eliminate the stigma attached to Medicaid. Instead of funneling money to the states to finance Medicaid as its own insurance plan, the Federal government could use these funds to finance health savings accounts (HSA) for eligible Medicaid beneficiaries. Individuals who pass an income acid test, for example 125% of the federal poverty line, would be eligible to receive an annual deposit of funds into a tax-free bank account (an HSA). Funds deposited into the HSA can only be used for healthcare expenses. The HSA beneficiary decides how he wants to spend the money—on primary care services, catastrophic insurance premiums, elective care, etc. Following the logic of my prior argument for more cash-based primary care, Medicaid beneficiaries could use their HSAs to pay cash for planned expenses and to pay the premiums on a catastrophic insurance plan.
This solution—tax-free savings accounts to pay cash for routine care and premiums on a catastrophic plan—is not just what I wish for the poor, but what I wish all members of society would have the opportunity to purchase. Today, due to Medicaid’s low reimbursement rates, many physicians intentionally limit the number of Medicaid patients they accept into their practice. With this solution, it would no longer matter to healthcare providers whether their patients are Medicaid (or Medicare) beneficiaries because all patients would purchase the same basic services and be covered by a private catastrophic plan. This solution empowers individuals to make decisions for themselves without intermediary meddling and removes the government from its unnecessary and inappropriate role as the poor’s medical care overseer.
Doctors should be committed to their patients first and worry about how much they’re being paid later. How do you reconcile your interest in policy and finance with the attention you should be taking in your patients?
Physicians commit themselves to nearly a decade (or more) of intense medical education—after obtaining their undergraduate degrees. These years of rigorous education give way to even more intense years of clinical practice. Unfortunately, many middle aged and older physicians are discovering that the burden of triple-documenting their clinical encounters, haggling with insurers for payment, and managing the regulatory environment is inhibiting the main reason they became a physician in the first place: to take care of their patients.
My interest in healthcare policy stems not from a concern with how much I will be paid once I become a physician, but concern for my freedom to determine the scope and direction of my practice. I am, of course, concerned with payments, but I am more frightened by the increasing dissatisfaction of physicians for the noble profession that so many men and women enter with the intent to become healers of the sick, not slaves to the Electronic Medical Records (EMR). I am one of thousands of first-year medical students across the country excited to begin our long medical careers; but, the statistics say in just a few years, a large number of my colleagues will be dissatisfied with their compensation, irritated with their workload, and concerned about the limited time they are allowed to spend with patients.
The market solutions I advocate for are not magic bullets, but they are progress towards fostering an environment that encourages efficient spending, rewards high quality delivery, and allows physicians to build the relationships for which most of us entered into the practice of medicine in the first place. Top-down regulation has consistently burdened the medical profession and driven up the cost of care across the board. If physicians do not begin speaking up for their interests, they will continue to see their autonomy wrested away by out-of-touch interests. Long term effects of physician silence will be bad for physicians and worse for their patients.
Let us seek to enable a healthcare ecosystem that empowers both buyers and producers of care to enter into mutually beneficial voluntary exchange without the interference of intermediaries with no vital interest in our relationships.
In Part III, we examine some fundamental questions about insurance, regardless of which political side of the fence you prefer on this issue.