Guest Commentary: Health Insurance Mandate Repealed. Now What?
By Lisa Lloyd
Contrary to popular belief, there is no crisis in health care. American health care is the best in the world as evidenced by foreigners flocking here for treatment when things get serious.
The real crisis is in the existence of a poorly managed bureaucracy that manages the protocol for its delivery. As a nurse practitioner, I provide the first line of medical treatment to those in need. I have had the opportunity to do so, in both English and Spanish, in a variety of settings including private practice, home health, urgent care and in clinics for the uninsured – many times all within the same week.
This experience has given me a unique ground-floor perspective into all aspects of the health care quandary allowing me to hear and see so many stories – the good, the bad and the frustrating – of the current state of health care industry. I have seen first-hand what works and what doesn’t work.
The key to improving cost and access to health care is shifting the bulk of the responsibility from the government to the individual and allowing the free market to offer services and drive down the costs. This requires the political will to reform the existing bureaucracy and laws that hamstring cost-effective yet viable approaches. We need more individual participation, increased consumer responsibility and less, not more, government regulation.
Without legislative reform to the health care system, everything else is just a Band-Aid instead of a cure. Many people lose sight of the fact that it is not just about getting health insurance, i.e., a piece of paper or policy, but rather having access to care when they need or want it. The former does not guarantee the latter, as I have so often witnessed. The narrative needs to be refocused on the transparency and availability of health care products and services, along with reforming bureaucracy to place responsibility in the hands of the consumer.
When it comes to insurance, informed consumers will always want a good value, and pay a reasonable price for a satisfactory product. Often, they are willing to pay even more for a premium policy or settle for a higher deductible and a more economical policy. It depends on what their priorities are, what level of risk they are willing to assume, and how much discretionary income they have.
They need to be able to choose first class, business class or economy, depending on what is important to them. What they do not want is to be denied coverage, given a limited choice of policies with high deductibles and premiums, or a one-size-fits-all package of benefits.
A market-driven health system would work as one would expect it to – driving out waste and inefficiency and rewarding high quality and lower costs with greater market share. Any consideration by Congress of health reform plans must rely on free markets and competition with a full understanding of the benefits such plans would produce for consumers, the federal budget and the American economy.
A good place to start for changing bureaucracy and lowering health care costs is tort reform. There should be reasonable caps placed on injury, pain and suffering awards. Patients who have been harmed should have recourse, and attorneys who defend them deserve to be reimbursed for their work. But the astronomical costs of health care are in some part due to excessive awards for patients and attorneys that surpass reason.
Another area for reform is the emergency room. ER personnel and providers should be empowered to triage and then treat only those who really need emergent care and refer all others to an urgent care facility or doctor’s office. It costs literally three times as much to treat a patient with a cough in an emergency room versus their primary care office.
Of the 140 million visits to the emergency room last year only 7 percent were classified as immediate or emergent i.e., heart attack, car accident, gunshot, not breathing, overdose, etc., which require care as quickly as possible. The remaining 93 percent would be triaged out to other clinics or their primary care physician because care can be administered in 24 hours or more. In addition, in every case, there should be some type of copay and recourse of billing. With increasing demand and a growing shortage of primary care providers, non-urgent ER use may only increase if reforms are not implemented.
Finally, to rein in health care costs and have adequate resources to help our citizens most in need, we must gain better control of Medicaid/Medicare fraud, waste and abuse, and illegal immigration. It is estimated that over 11 percent of the visitors to an emergency room are by illegal immigrants which translates to more than 15 million visits per year, at a cost of approximately $4 billion annually. Where legal immigrants are more likely to have established a primary care provider, the undocumented immigrants use the more expensive ER facilities by default. And while this is certainly a lot of money, it is overshadowed by the amount of improper payments made through Medicaid and Medicare.
Estimates by the FBI say that improper payments for health care run as high as $80 billion. Budget expenditures for both programs are over $1 trillion and rapidly approaching $2 trillion. Abuse is so extensive that average annual recoveries only slightly exceed the enforcement budget of $2 billion.
We can and must do better.
Many people dream of a single-payer solution. We currently have a somewhat single-payer system for our veterans, and it does not provide adequate services. Even the new Veteran’s Choice program is restricted to those who meet an extended set of time and distance related criteria.
If veterans had their choice of providers, many would not choose the VA. The reason is not because of the services provided – they have been said to be excellent – but because of scheduling, location and other individual preferences. The fact that the VA is a single-payer system has left so many veterans without adequate care, and without viable alternative options. A strictly single-payer system is not efficient, effective, nor agile enough to respond to the needs and wants of American consumers.
A major stumbling block to any insurer plan’s profitability is providing catastrophic care or covering individuals with pre-existing conditions. I propose that a public-private partnership be developed between the already existing VA system and private entities with supportive funding from the federal government to provide health care to individuals who skew the premiums for the otherwise healthy majority of the population – essentially those individuals who fall outside that one standard deviation on the bell curve. There is no perfect solution, but more state or federal government control is not the answer, and neither is inaction or complacency.
I believe that President Trump does not see issues as conservative or liberal, but through the lens of dollars and cents, efficiency and efficacy. He asks, “Is this a good deal for the country?” and “Are we getting what we are paying for?” He is in a position to make positive changes and has the political will to do so. As a result, I definitely believe there is hope for the bureaucratic crisis in health care management and for positive, meaningful health care reform.
Lisa Lloyd has a Master’s in Business Administration, a Master’s of Science in Nursing and currently works as a nurse practitioner in private practice, urgent care and volunteering at a clinic for the uninsured. She is a Republican candidate for Congress in Maryland’s 6th District, where she lives with her husband and four children.