Today’s inbox contains a new healthcare prescription, The American Health Care Plan, by Haskins & Karnick of The Heartland Institute that purports to “provide Americans with a pro-liberty, conservative proposal to fix the U.S. health insurance system, lower health care costs, and create universal access to health care services.” Neither author appears to be connected to the healthcare industry, and both seem to be researcher-writers with a political bent.

This Policy Study begins by briefly outlining the failures of the Affordable Care Act, commonly known as “Obamacare,” and the shortcomings of our current health care system. It then offers to lawmakers and the public a commonsense plan to create a pro-liberty health care system that would make health coverage available to all Americans without compromising quality or putting individual liberty at risk.

The plan is laid out in two distinct parts. The first (Section 2, beginning on page 8) describes a proposal to reduce health care costs and establish a new “Health Ownership Accounts” program, which would supplement and ultimately replace the United States’ existing and irrevocably broken employer-sponsored model.

The second part of the proposal (Section 3, beginning on page 17) would provide substantial improvements and reforms to Medicaid, giving lower-income and poor families greater access to higher-quality health care services. <Source>

The “plan” is a top-line collection of various concepts that may be helpful in reforming today’s quasi-Obamacare health delivery system. Unfortunately, the “plan” is not a plan that can be implemented. It is not backed with the specific language of enabling legislation, and it fails to address fundamental healthcare issues.

Of course, the so-called plan muddles the distinction between those physicians, facilities, and support workers who actually provide hands-on healthcare and those insurers who administratively control access, authorization, and payment for medically-related services and durable medical equipment.

Questions rarely asked or answered...

(1)  What is the role of insurers in the overall health care delivery system, and how much of this costly, inefficient infrastructure can be disintermediated (eliminated or reduced) by an automated system based on a set of data descriptions and interconnection standards that allow disparate automated systems to work together as a single entity? Not a single-payer entity, but an underlying system to facilitate the flow of both medical and financial information. The present system is a failure and a hodge-podge of crippled systems that rarely speak the same language. In my estimation, systems that attempt to combine financial and medical test results and reports (especially those dealing with images of archived data) are doomed to failure by the sheer size and complexity of such systems.

(2)  What is the role of the insurer in the approval, delay, and denial of medical care as recommended by physicians?

(3)  Are gatekeeper primary care physicians necessary to rationalize the utility of specialist care? Can patients adequately manage a self-referral system?

(4)  What is the mechanism for caring for the uninsured, persons unable to afford prescribed care or medications, and a population segment perpetually in transit?

(5)  How does the paradox of healthcare savings accounts align with reality? Specifically, when a layman is asked to blindly shop for medical insurance based on price and coverages for as yet unknown medical conditions? The truth is that physicians recommend other physicians, the use of specific facilities, and the use of durable medical equipment. Few individuals may be willing to interrupt that linkage to substitute cheaper alternatives – some of which may be unacceptable to the treating physician for various reasons of location, access, quality, and speed of delivery.

Bottom line…

The idea that the ills of our current healthcare authorization, delivery, and payment system can be adequately addressed in a 28-page document is ludicrous. That this document is a plan rather than a collection of talking points is ludicrous.

I am not taking a position on the concepts contained within the paper other than to point out that this paper is symptomatic of the failure of the GOP to address the overall healthcare issue. It is one thing to give impassioned speeches about the evils of Obamacare, socialized medicine, and a single-payer system – loudly shouting "repeal and replace" – but never having an adequate replacement available. Perhaps an impossible task for “go along to get along” politicians taking special interest money and conditioned to outsourcing the heavy work of actual implementation to various Executive Branch agencies.

We are so screwed, especially by a system that is defective by design, so the billions attributable to waste, fraud, and abuse can accrue to those willing to game the system.

-- steve

“Nullius in verba.”-- take nobody's word for it!

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