In my last blog, I began the subject of liberating the doctors. We’re following the work of John C. Goodman of the Goodman Institute, who tells us we need to consider four principles if we want to take full advantage of the knowledge and experience of doctors in fixing our broken healthcare system.
In Part I of this series, Goodman told us we must:
- Give doctors the freedom to repackage and reprice their services
- Encourage supply-side innovation
Today, we will discuss his other two recommendations.
Start with private sector opportunities.
In an ideal world, doctors would be able to approach Medicare and make a deal. In return for being paid in a different way, they would guarantee lower costs and a higher quality of patient care. We shouldn’t give up on that idea, but the odds will be much better if the payer is a private entity. For example, DPC doctors initially refused to deal with any third-party payers. That has changed. One of the fastest-growing trends in private insurance is employer payment for direct primary care.
To my knowledge there is no public sector insurance plan that has taken advantage of this opportunity. Certainly not Medicare or Medicaid. That is not surprising. Medicare was the last insurer to cover prescription drugs. It has been way behind the private sector in many other ways – including adopting the opportunities created by telemedicine. Yet, there is an exception to this generalization. That is the Medicare Advantage program– where roughly half the beneficiaries are enrolled in private insurance plans. MA plans are allowed to specialize and become centers of excellence for specific types of care.
For example, there are special insurance plans for diabetes, for congestive heart failure, for lung disease, etc. These plans are becoming innovators in chronic disease management. Some doctor-run MA plans, for example, make insulin free—as well as consultations with an endocrinologist. By investing in these upfront costs, the plans avoid the greater costs of emergency room visits and hospitalization. One way to think of these special-needs plans is to see them as an extension of the DPC model applied to specialty care. There is no reason in principle why doctor-run centers could not provide specialist services to all private sector insurance plans.
Deregulate the medical marketplace.
Before seniors were allowed to talk to their doctors by phone, Medicare bureaucrats spent thousands of hours trying to decide what tasks were appropriate for phone consultations and what fee should be charged in each case. Now that the Covid medical emergency is officially over, they are at it again.
If a doctor calls a patient with the results of a blood test, should that count as a consultation? How much should be charged? Somehow, lawyers, accountants and other professionals manage to resolve issues like these without an army of bureaucrats looking over their shoulders.
The medical marketplace is by far the most regulated of any consumer market. That is unfortunate. Almost any good idea that really would lower costs, improve quality and expand access to care is likely to face regulatory barriers. Here are a few changes that would liberate doctors and patients for the benefit of both:
- Allow employers to put money in a Health Savings Account (HSA), from which employees could make a monthly payment to a DPC doctor of their choosing.
- Allow employers to provide free services to the chronically ill without making employees ineligible to have an HSA.
- Allow doctor-run specialty plans to have access to the (Obamacare) exchanges and to the employer market in the same way they are available in the Medicare Advantage program.
- Allow enrollees in traditional Medicare and in Medicaid to have access to DPC services and to doctor-run special- needs plans for the chronically ill.
There you have it; four principles to revolutionize our healthcare system and liberate the doctors! It’s about time we let those who deliver healthcare tell us how to manage the delivery system; not those who are only in it for the money.
