"Healthcare for all — A well-versed slogan of Utopianism" — Adam Tabriz, MD
Healthcare For All: From From Buzzwords to Realism
The Fundamental Necessity to Institute Quality Healthcare for Everyone
Direct primary care, Medicare-for-all, affordable care act (ACA), and universal healthcare are some of the thousand buzzwords floating around within the current healthcare planetary. In fact, in most cases, the resentment and hostility associated with their enthusiasts are much more robust to the point beyond proportion than what they may individually represent.
“THE MOST EFFECTIVE WAY OF MAKING PEOPLE ACCEPT THE VALIDITY OF THE HEALTHCARE VALUES OR CONCEPT THEY ARE TO SERVE IS TO PERSUADE THEM THAT THEY ARE THE SAME AS THOSE THEY HAVE ALWAYS HELD, BUT WHICH WERE NOT PROPERLY RECOGNIZED BEFORE”
Therefore, I intend to shed an open-minded light on the dark side of today's medical culture. The ultimate pragmatism may only be through making healthcare coverage for all in the short run and quality medical care for every individual in the distant future.
For those who have reached this far in my narrative, I must highlight if you are convinced that the only way we can ensure quality healthcare for all is through government intervention. Or at the other extreme, they believe that boycotting the insurance industry and government-run programs is the ultimate solution. Reading the rest of this chronicle will probably fail to convince you of the alternative options. Rest assured, there is no one silver bullet for the new world healthcare crisis we live through. Still, undoubtedly sundry realistic and Practical approaches exist to build a practical tool and implement the necessary strategies to simulate one.
We must Entertain Options.
The option is the most imperative attribute of any deed in the human's life, more so in healthcare.
“I may be running out of options, but running out isn’t an option,” said Mark Lawrence, at Prince of Thorns
The option is an opportunity, as the chance is the facilitator of competitiveness and quality of care. Former is the missing piece of the majority of proposed solutions.
Let's examine some of the significant Resolutions
Obamacare
The Patient Protection and Affordable Care Act (PPACA), often shortened to the Affordable Care Act (ACA) or Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. The Health Care and Education Reconciliation Act of 2010 signifies the U.S. healthcare system's most significant regulatory renovation and expansion of coverage since the passage of Medicare and Medicaid in 1965. The individual mandate to purchase coverage is the fundamental component of the ACA, which, Short, ACA is rendered obsolete. Furthermore, to extend the range to individuals who do not qualify through the state Medicaid expansion program, the federal government has implemented subsidies to reimburse private third-party insurance premiums to outspread coverage to the eligible population. They do so based on their proof of income with cost. The Congressional Budget Office estimates that this funding would have cost about $130 billion from 2017 through 2026.
Direct Primary Care
In recent years a new system of cash for service has come up in the country, gaining significant popularity mostly among the physicians practicing in the Midwestern and southern states. Its fundamental business model is primarily based on the concept of the free market, known as Direct Primary Care (DPC). The model has revolutionized healthcare by allowing patients to pay physicians directly for their care. Insurance companies are eliminated from the billing process under DPC and in no way can influence the care patient desires. DPC encompasses different healthcare delivery systems based on financial relationships between the patient and the doctor. Direct Primary Care is about more than reimbursement. It signifies that physicians are starting to step out of the woods and are educating their patients to do the same, making it the most important and valuable move of the past few decades.
Medicare for All
The original United States National Health Care Act or the Expanded and Improved Medicare for All Act is a bill introduced in the United States House of Representatives by former Representative John Conyers (D-MI) in 2003, with 25 Cosponsors. As of October 1, 2017, it had 120 Cosponsors, a majority of the Democratic caucus in the House of Representatives, and the highest level of support the bill has received since Conyers began introducing the bill in 2003. The act would establish a universal single-payer health care system in the United States, the rough equivalent of Canada's Medicare and Taiwan's Bureau of National Health Insurance. Under a single-payer plan, most medical care would be paid for by the federal government, ending the need for personal health insurance and premiums and altering specific insurance companies to provide supplemental coverage when non-essential care is required. The national system would be partly paid for through taxes replacing insurance premiums and savings realized through the provision of universal preventative healthcare and eliminating the insurance company overhead and hospital billing costs. Medicare Parts A, B, C, and D. are the four types of amended coverages available to eligible individuals under the Medicare proper. Each Medicare Part covers different healthcare-related costs. While the Centers administer Medicare Part A and Medicare Part B for Medicare and Medicaid Services (CMS), Medicare Part C and Medicare Part D are managed by private insurance companies.
Medicaid Expansion
Medicaid expansion is a provision in the ACA that called for expanding Medicaid eligibility to cover more low-income Americans. Under the expansion, Medicaid eligibility would be extended to individuals with incomes up to 138 percent of the federal poverty level.
Healthcare Freedom Act
Recently Congressman Chip Roy (R-TX-21) introduced the Healthcare Freedom Act. It seems to be the reformed version of the already existing policy, Health Savings Account, or HSA, a tax-advantaged account that enables the patients to pay for current or future healthcare expenses. When combined with a high-deductible health plan, it is meant to offer savings and tax advantages that a traditional health plan can't duplicate. The congressman's proposed plan establishes what he calls "healthcare freedom accounts" (HFAs) which presumably act as "health savings accounts." But that is with more flexibility to focus on close patient-physician relationship within the direct primary care (DPC) settings, provide portable catastrophic coverage, and give control back to the individual. He projects that HFA will reduce costs. The bill would prevent money deposited by employers or individuals from taxing. Up to $12,000 per year can be deposited into the account. That limit is extended to $17,000 for anyone over 55.
The Drawbacks of the Current Solutions
Most solutions today have been subjected to the Spectrum of challenges and their associated pitfalls. For example, the constitutionality of any component of the ACA is currently being challenged in the federal court. Besides constitutionality, one of the major flaws of the ACA is its radical extension of public funds through the federally subsidized program to the private corporations with very little accountability and transparency in place, rendering it the wastebasket for the taxpayers money.
Many stakeholders in the healthcare industry have promoted DPC for its benefits, as it helps patients save expenses on primary care and other ancillary services such as clinical tests. The system also allows patients to spend more time with their doctors and choose from whom to receive care. DPC is a great tool but also a unique challenge to independent physicians. Because of its peculiar business model, the DPC is vulnerable to being taken over by corporate companies through the "Uber scheme," making the already corporatized system shoddier. The lucrative nature of DPC is very appealing within the current corporate-dominated market and an excellent opportunity to gain control over the medical practice. Direct primary care overhaul by the corporations would ignite a new flame within the already existing brush fires doctors face from the managed care systems and insurance companies.
In addition, despite the insurance industry's takeover of the healthcare arcade- by no means would it be feasible to pull a blind eye over the mainstream 3rd party payer alternatives by abruptly switching over to the DPC or concierge medicine. DPC is the preliminary step toward physician empowerment and genuine patient-centered medical care, so it is on the path to serving as a fundamental reform initiative, which we can appreciate from the recent HFA bill proposed by congressman Chip Roy.
Medicare for all, on the other hand, is complex. Historically Medicare has been less than perfect, despite representing the better of the two evils amid private and government-run programs. Still, patients must utilize supplementary government-sponsored subsidized programs, including prescription drug coverage. Medicare Part C and D are administered through private insurance companies to address drug coverage; hence, another wastebasket for the federally allocated funds.
Medicaid extension is a federally subsidized state-run program with limited Application. It provides extra assurance to low-asset candidates, including children, pregnant women, parents of eligible children, people with disabilities, and the elderly needing nursing home care. Naturally, such expansion has a limited scope and much shorter benefit terms.
The Significance of Realistic Attitude
Pessimism, Realism, and Optimism are a mixture of the attitudes around the healthcare system. Patients are frustrated, physicians burn out, politicians are over-optimistic, and pessimism is the evolving attitude. Nevertheless, natural aptitude is a rare attribute amid the ongoing crisis. Realism is a required optimum but requires transparency and knowledge, the latter of which is hardly attainable beyond proper transparency.
So, what is the Realistically best Healthcare System?
A sensible healthcare system would ultimately address every individual's medical needs based on the available resources and economic status of the patient's home community. A realistic option may not necessarily be within the direct and immediate reach practicality, thus may require additional steps, which may fail to seem ideal at the beginning, nonetheless be the only realistic alternative to help attain the ultimate goal. Perhaps, Medicare, with all the flaws integrated within and the degree of dependence it has created among the eligible, would be close to impossible to be gotten rid of without implementing a fallback system, even though the contingency option may not be better than the original solution. It also deserves to be signified — — as most politicians fail to see beyond the substitute juncture, bushwhacking the alternative solutions under its immediate outcome.
The utmost grail is establishing and maintaining a free and transparent healthcare marketplace where everyone can afford a personalized, high-quality medical service. The optimum healthcare solution is the best to start with by addressing the immediate goal.
The swiftest objective is to make sure all Medicare beneficiaries maintain their coverage without the prerequisite of subsidizing private corporations. While slow, the transition can be smooth with fewer regulations. Medicare is vast, bureaucratic, and inflexible; it requires ingrained structural reform. Its deficiencies undercut patients' comprehensive and integrated care while increasing costs and generating debt. It eventually will require dissolution as the primary solution.
Medicare's insufficient benefit package would lead to an enormous gap in coverage, requiring patients to buy costly supplemental insurance. One major defect is the inadequate solution for prescription-drug range and the complex framework.
Expanding Medicaid is not an ideal long-term solution if quality healthcare for all is anticipated; nevertheless, it is a legitimate stepping stone to a fundamentally operational solution that is flexible and affordable. However, the expanded Medicaid to all will require federal support by allocating already established Medicare funds through a transparent, structured, accountable gated stream.
Municipality of negotiation between the public and private entities
Healthcare Leaders must avoid direct negotiation between private and government entities unless it is short-lived or essential. Still, to avoid unnecessary pitfalls throughout the transition, Healthcare leaders must practice such talks in the smaller community segments as permissible. For instance, Negotiating drug formulary and price by the county administration with the help of domain experts is the most ideal; as the socioeconomic and community standards of medical practice vary between municipals, thus logical to entertain the negotiation of drugs independently. The same would apply to conciliation for laboratory and radiology services within the discretion of the county governance. Due to the potential economic variation from one borough to another and the variability of the standard of care for the same reason, it is prudent to respect the autonomy of individual target populations. But unfortunately, in contrast to the decentralization of negotiation historically, it has been advantageous for the corporations to maintain the talks as centrally as possible at the state or national scale. Since every clinic, physician and provider offer a different quality of care, and every community holds a contrasting healthcare market, physician fees schedule is also ideally determined independently by every metropolitan district.
The Concept of bidding in the Expanded Medicare system
The bidding system has been applied in many aspects of government projects and negotiations with private entities. It creates competition, improves quality, and reduces costs. It would also be practical for every county to adapt bidding practice while negotiating for drugs, medical supplies, and services with the private businesses.
Based on the concept of providing options with no obligation, individual districts must have the opportunity to opt-out of the Medicaid system in reflection of their internal referendum, economic status, and market standing while maintaining access to the transparent negotiated pricing from other counties. To avoid neglectful Opt-out, we must entertain it contingent on purchasing private insurance or available cash assets in the account dedicated to health. Latter must also respect individual choice without jeopardizing the right of fellow citizens. To prevent kickback practices and monopoly, the recourse to import prescription drugs under a well-structured quality assurance program should be available to everyone, as It will respect the fundamentals of the free market.
The county and state legislators must make necessary efforts to widen the Spectrum of options by promoting insurance coverage purchases across the state line, increasing competition, and reducing costs.
Incorporating social and individual determinants of health and wellness by each county and creating benchmark studies between counties and clinics make the outcome transparent to the public, gradually prompt a competitive environment, and establish free open sooq. We should empower patients by positioning them in control of their medical records, supporting physicians by allying with independent physician collaborators in the county and incentivizing them to contribute. Engage every stakeholder throughout the process without the bias of financial incentives.
The ultimate goal is to equalize the value of care and cost between the cash, Medicaid, and private insurance and a Healthcare for all by eliminating the socioeconomic and geographic barriers.
