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Healthcare is the political football of the midterm elections. But unlike the game of football, there are no rules. And the goal is to win - not for the benefit of the team (the voters) but to gain status and power. Politicians are looking for a sound bite that catapults them into the spotlight. Spartacus was a dud. People like free stuff. Let's try Medicare-for-All! Of course, the ads won't mention that taxes will be doubled and private health insurance is essentially outlawed.
Currently, eight bills proposing variations of federally sponsored healthcare are on the horizon. If one bill fails, another one is in the queue. The government's attempts to improve our "healthcare system" by top-down control of doctors and their patients have failed. For example, electronic medical records meant to streamline and make medicine more efficient have done the opposite: they are costly, non-interoperable and waste 50 percent of doctors' time. Insurers exited the ACA marketplace - decreasing choice and competition. Lower insurance premiums were a pipe dream, while the profits of pharmaceutical companies and insurers soared. Many people were unable to afford insurance and certainly could not "keep [their] doctor" whom they liked.
Not only is it prohibitively expensive, but central control will bring use of more government guidelines, some of which have proven to not be in patients' best interest. For example, in contrast to private medical organizations, the U.S. Preventive Services Task Force recommends biennial mammograms for those over 50 years. Yet the incidence rates for invasive breast cancer in women under age 50 has increased since the mid-1990s and breast cancer is more common in African-American women than white women in the under-45 age group.
Likely ignited by the limited choices on ACA exchanges, the personalized medical care movement was gaining steam. Accordingly, the Trump Administration made increasing healthcare freedom a key priority. A year ago, President Trump released an executive order "Promoting Healthcare Choice and Competition across the United States."
First, the president expanded association health plans, increasing the options for small business and self-employed business owners. These plans allow certain businesses to join together across state lines to purchase health coverage. Next, to provide more options for individuals facing high premiums a new rule allows for the sale and renewal of short-term, limited-duration plans that cover longer periods than the previous maximum of less than three months.
Last week, a new rule to expand health reimbursement arrangements (HRAs) was proposed. An HRA is a type of group health plan that allows employers (only) to fund medical care expenses for their employees on a pre-tax basis. Any unused portion of the HRA in one year may be carried forward to subsequent years. The rule would allow HRAs to be used to fund both premiums and out-of-pocket costs associated with individual health insurance coverage.
There is more to be done. We have to create a medical care world based on choice and competition and high quality at a reasonable cost. A world where bigger is not better and simplicity is a virtue: decreased reliance on third party payers, transparent affordable prices, and Health Savings Accounts (HSAs) for all. HSAs could be funded directly by employers, or by tax credits, or allowing everyone to earn a certain amount of money free of income and payroll tax to go into a medical expense account. The funds could be used to pay for anything reasonably related to healthcare as determined by the states, e.g., insurance premiums, deductibles, co-pays, direct patient care monthly fees, and health sharing ministries' costs. The funds would be taxed if used for another purpose. Major medical (catastrophic) insurance policies would be available to all with state subsidies for those not working.
In this brave new world of providing broad access to excellent, but affordable medical care, the financially and physically vulnerable are not forgotten. There could be a tax credit for donations to charitable organizations that pay medical bills, modeled on tuition tax credits, up to a limit separate from the medical expense account. If Americans still want a third party to insure them for all health-related needs, they have the option to do so.
Don't be fooled by sound bites: control is not compassionate. Turning over our lives to others places us at their mercy. The happiest people -- even the disabled chronically ill -- are those who have control -- the feeling that life's activities are "self-chosen."
The government should set some basic rules, free from lobbying influence of industries that will benefit from government-run healthcare. And let patients and physicians take control of the ball and run with it. When the goal is giving patients the opportunity to choose their own path to great medical care -- rather than a politician's short-lived glory -- freedom always wins.
Dr. Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard's Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.
