Clinical doctors can readily understand the continuing failure of the U.S. health care system. The attending physicians for Patient Healthcare–Washington, both legislative and executive branches–keep trying to treat the health care’s symptoms while refusing to seek the etiology of illness.
To uncover the root cause for health care system failure, I applied the techniques and experience garnered by the business world such as network assessment, SPAcE analysis, value chain review; various audits and matrices; environmental scanning; Kaizen; Poka-Yoke; etc.
The root cause diagnosis in Patient Healthcare became evident: cancer. Washington and its bureaucracy have become malignant, metastasizing to every part and aspect of health care. Federal bureaucrats practice medicine without a license, viz., pharmacy benefits managers, federal clinical algorithms, and authorize (or not) treatments needed by patients.
Rather than palliate or mesmerize Patient Healthcare as the Beltway has done for fifty years, we need to cure this patient. The cure for any cancer is straightforward–Cut It Out. When the cancer is Washington, the cure is to return health care authority to We the People, or as I refer to us, We the Patients.
The most common reaction to this recommendation is, “Ridiculous! Politically impossible! Can’t be done!” The second reaction is usually, “All solutions come from Washington, don’t they?”
The proper response to the first reaction is, “They work for us, we have the power, not the other way around.” We should demand what’s right, what we want, and not meekly accept what Washington will allow.
Those who think all solutions come from the District of Columbia should answer two questions. (1) If you manage a baseball team and your starting pitcher has lost every game for the last fifty years, do you really expect him to win this year’s World Series? (2) Does Washington’s one-size-fit-all make sense? For example, should Rhode Island and Montana have the same federal health care mandates? Both have one million residents. Rhode Island has 5500 doctors within 1212 square miles, and Montana has 1100 physicians scattered over 145,000 square miles.
The cure for Patient Healthcare is called StatesCare, where Washington is no longer in charge. We the Patients, in our states, decide what health care system(s) we want and how to allocate our funds.
If 39 million Californians want single payer; if 3.5 million Oregonians want universal health care; and if 29 million Texans want a market-based system, 71.5 million Americans should be free to choose their own health care systems. If several states want to create a regional system, they should be free to do so. States could arrange for residents’ health care across state lines.
A market-based health care system with a safety net has been modeled both medically and financially in the new book, Curing the Cancer in U. S. Healthcare: StatesCare and Market-Based Medicine. A market-based system is simple. Patients have very large HSAs. They shop for and pay directly for most care. People can purchase very high deductible, catastrophic insurance for unexpected disasters. Sellers of goods and services compete for consumers’ (patients’) dollars based on what consumers want: quality defined by them as well as price. Washington plays no role. There is no third-party decision-maker and no billing or coding. Administrative costs are minimal, as there is no federal administration, regulation, or compliance oversight.
Options for safety nets for medically vulnerable individuals were also modeled in Curing the Cancer in U.S. Healthcare, including state-supported HSAs and high-risk pools. States will decide what form of safety net they construct rather than being forced to follow a one-size-fitsall federal mandate.
Federal control of health care is unconstitutional, regardless of what form it takes: single payer, Medicare for all, universal health care, or socialized medicine. The Tenth Amendment to the Constitution reads as follows: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.” Health care was intentionally not delegated to the federal government and thus is “reserved to the States respectively, or to the people.”
Federally controlled health care–the cancer–is returning the U.S. to a tyranny similar to the one we rebelled against in 1776. For example, Section 102 of the Medicare for all bill, H.R. 1384, provides for universal entitlement, meaning the federal government is responsible and in charge. Individual Americans are neither–responsible or in charge of themselves. We are forced to accept what Washington says we are entitled to, not what we choose. Federal health care takes away our freedom.
The combination of StatesCare and market-based medicine is the CURE for health care.
Relieving Washington of its power restores Americans’ freedom and their right to choose. StatesCare enables us to recoup more than a trillion dollars a year spent on health care administration, money that can return to our pockets, or can augment patient care.
By directly reconnecting buyer/patient with seller/provider, market-based medicine restores free market forces to a system that has suffered from their absence for more than 80 years. Buyers’ need to economize will drive spending down. Competition among sellers will drive prices down while simultaneously increasing access. Those providers unwilling to compete and deliver timely service will quickly find their waiting rooms empty. Meanwhile, with market-based medicine, willing providers will be paid more than with any pre-determined government reimbursement schedule.
The essence of StatesCare is that people in their states decide health care for themselves. No one outside state lines has authority within state borders, not me, not some panel of self-styled experts, and certainly not Washington. While the evidence has led this author to advocate for market-based health care, my opinion should have impact only in my home state.
Americans have a constitutional right to be free, to choose for themselves. That includes their health care (the service) and their health care (the system).
Deane Waldman is a pediatrician and pathologist. He is the author of Curing the Cancer in U. S. Healthcare: StatesCare and Market-Based Medicine.
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