Restoring Healthcare in America-Is It Possible?

Deane Waldman, MD MBA - 17/12/19

U.S. healthcare is failing: it doesn't deliver timely care and spends money we don't have and can't afford. Can healthcare be fixed?

In 2018, the average American family spent $28,166 on healthcare costs. The same year, the U.S. poured $3.65 trillion -the GDP of Germany-into its healthcare system. Despite this incredible outlay, maximum average wait time to see a primary doctor increased to more than four months, and "47,000 veterans may have died waiting for . . . medical care."

Two actions will restore healthcare so that We the People can get timely, affordable care. Without doubt, Americans have the need, but do they have will?

Step 1: Excise cancer

The first step is to remove the malignancy that is Washington and its federal bureaucracy. Any bureaucracy has only one function: to help all the other parts of a system or organization do their jobs. Bureaucracy is not supposed to expand in to morbid obesity. Bureaucracy should not take over control of all the other parts of a system. Yet, that is precisely what has happened in healthcare.

Congress and its attendant federal agencies, such as Centers for Medicare and Medicaid Services and the Federal Drug Administration to name two among hundreds, control both providers and patients. Bureaucrats approve or deny treatments, determine what drugs a doctor can use, and dictate payment schedules. The federal healthcare bureaucracy controls both supply and demand in the healthcare market and pays itself handsomely for doing so.

In 2018, Washington paid its bureaucracy directly and indirectly no less than 1.4 trillion "healthcare" dollars. That is $1,400,000,000,000 worth of patient care that Washington took away from the American people.

Since Washington has been fixing healthcare for fifty years, Washington is responsible for the sad state of today's system. It is time to give someone else a chance. That "someone else" was specified in the U.S. Constitution.

The Tenth Amendment to the Constitution reads as follows. "The powers [meaning authority or control over] not delegated to the United States [federal government] by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people." Federal control of healthcare is not only ineffective and unaffordable: it is unconstitutional.

Step One to restore healthcare is called StatesCare. The decisions about how to structure healthcare should be in the hands of We the People in their states, not federal politicians and bureaucrats in the Beltway. If 39 million Californians want single payer; 28 million Texans want market-based medicine; and six million residents of Washington state want their version of universal healthcare, 73 million American should be free to choose their own healthcare. Assuredly, they can do a better job than Washington has done.

Step Two: Reconnection

To restore healthcare requires resurrecting the proper doctor-patient, that is, with no one and nothing in between. The patient should be the only one deciding how to spend his or her money and choosing what care he or she will receive. As long as the third party-government or insurance-controls the money, it makes medical decisions. Third-party payment structure disrupts any effective connection between provider and patient.

Reconnecting the patient with the doctor, cutting out the middleman third-party payer, is called market-based medicine. In this form of healthcare, the patient chooses the provider as well as the care, and pays out-of-pocket. For the unexpected big-ticket medical expense, there is high deductible catastrophic insurance. Add a safety net for medically vulnerable Americans and that's it.

Market-based medicine restores the patient to primacy in healthcare. Care will be available when you need it at a price you can afford. No one will die in the streets. No one will succumb to illness waiting in line for care. And with market-based medicine, the U.S. won't go broke paying $40 trillion for a Medicare-for-All plan that won't deliver care.