How to Get Timely, Affordable Health Care

Deane Waldman, MD MBA - 17/12/19

To get what you want, you must first decide what that is. If you believe media reports on healthcare, the public wants to save money and to have health insurance.

Money and insurance are not our primary healthcare desires. What we want is simple and universal: access to timely affordable health care.

Federal politicians have been promising to deliver timely affordable care to Americans for more than half a century. Their repeated "fixes" have brought healthcare to its present sorry state-spending too much and not getting care.

How NOT to get timely, affordable health care

In 1965, Washington passed Medicare promising it would provide all the care needed by retirees. After 50 years of federal (mis)management, a 2018 internal audit projected that the Medicare Hospital Trust Fund will be insolvent, "broke," by 2026. Within seven years, seniors won't be able to get in-patient care.

Also in 1965, Congress created Medicaid, a no-charge-to-patient program supposedly administered by the states for the "disabled, aged, and blind." Today, Medicaid has enrolled 74 million Americans, 23 percent of the U.S. population, including millions of healthy, able-bodied adults and 30 million healthy children. Enrollees' access to care is limited because one third of U.S. physicians refuse to see new Medicaid patients due to bureaucratic hassle and low, fixed and highly delayed payments by the government. As for timeliness of care, 752 residents of Illinois died while waiting for Medicaid authorization for care. Such "death by queueing" is not limited to Medicaid. With government-supplied Tricare coverage for our armed forces, "47,000 veterans may have died" waiting in line for care.

EMTALA (Emergency Medical Transport and Labor Act of 1986) was Washington's solution to patient dumping-transferring uninsured patients from one hospital to another. The law required essentially all hospitals to treat patients who presented to an emergency room regardless of whether the patient had a payment source. EMTALA's unintended adverse consequence was creation of the unfunded mandate, responsible for hundreds of closures of rural hospitals as well as cost-shifting by those still open.

In 2010 came the Affordable Care Act, which achieved the precise opposite of its name. Insurance premiums-unaffordable before the ACA-doubled after it was implemented. As for access to care, Obamacare increased maximum average wait times from 99 days to 176 days to see a primary care physician.

The latest proposed fix for healthcare, Medicare-for-All, continues Washington's tradition of one-size-fits-all, Father Knows Best mandates. It would prohibit private insurance, lower already low payments to doctors (further extends delays), and would spend $30-40 trillion we don't have. The combined GDP of all nations on earth is $87 trillion.

The way NOT to get timely affordable health care is to expect Washington to deliver.

How to GET timely, affordable health care

Having timely affordable care starts with StatesCare: take control away from Washington and return authority where it belongs, We the People in their states. Two benefits will quickly accrue. First, we can recoup more than one trillion "healthcare" dollars currently being wasted on federal bureaucracy and use it for patient care.

Second, when Americans are no longer forced to obey federal healthcare mandates, they can choose the structure that best suits to their local needs and resources. The system most likely to provide timely affordable health care is market-based medicine. This approach reconnects patient with doctor without a third-party payer making decisions. Patients shop for and pay for care. Thus, they have a strong incentive to economize. Providers compete for patients' (buyers') dollars, driving prices down. Add a safety net for the medically fragile and truly impoverished, and that's it. Details and financial modeling are available in "Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine." There is virtually no bureaucracy. It puts patients are back in control of their care and their money.

Finally, Americans can get timely, affordable health care.