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To solve U.S. healthcare crisis, think small, not big


Ten steps to widespread adoption of free markets offering competition on healthcare price and value.

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.

American healthcare, with all its included industries and administrative bloat, is more expensive than ever. From hospital charge master pricing to prescription medications to government-mandated insurance; all parties agree that costs are way out of hand. To fix the problem, we must examine human behavior, history, and cost drivers, at least in brief.

In the last 100 years, we have seen the rise of bureaucrat care: the toxic milieu of employer-sponsored health insurance, federal dominated Medicare and Medicaid, HMOs, ACA-regulated insurance, and now, to add insult to injury, the endless conglomeration of health plans, pharmacy benefits management, pharmacies, and big box "providers" like CVS-Aetna and the vast UnitedHealth Group empire. We have gone from individual health to group health to population health. The common thread here is government intervention since World War II in healthcare financing policy.

We have seen individuals shifting their health responsibilities to these bureaucracy-laden behemoths with disastrous results. Rates of lifestyle-caused diseases like obesity, diabetes, coronary artery disease, and cancer have all increased despite technology and advances in screening and medical treatment.

The fatal flaw? The bureaucracy cannot change an individual’s behavior. This is one of the myriad reasons population health fails. What then is the big solution? How about thinking small, not big? Small as on the individual level taking human motivation and action into consideration.

Individuals have their own value system based on their ethics, morals, motivations, preferences, risk tolerance, experience, etc. And since this is America after all, individuals must be free to exercise their individual liberty and choose what benefits to pursue and risks to take. This concept is what has made the American economy flourish-except in industries where it is pushed aside, like healthcare.

History proves: for the best outcomes and use of resources, we must allow individuals to make individual choices. This will work in healthcare too if allowed. Let patients decide on their own whether or not to pursue and buy insurance, preventive care, and other healthcare services, and bear the consequences of the decisions. People take care of the cars they work, scrimp, and save for. They tend not to keep after the service on cars their parents purchase for them.

Everyone is entitled to own their own body and must therefore be responsible for their own routine care and maintenance. Insurance is a modern day concept to mitigate risk for a prepaid price, not prevention or cure. This is why we must get the government-and its financing- out of healthcare; allow a free market to flourish. In a free market, people are free to choose their own physician, lab, and hospital based on their individual value systems.

Think this is fantasyland? Nope. It is already working where tried. Direct patient pay solutions like direct primary care and other patient direct-pay healthcare options engage patients and physicians for best outcomes and prices. It is also the ethical solution.

What will it take for a widespread adoption of free markets offering competition on price and value, like we have for almost every other American sector?

Here are the steps that can get us there:

1. Don’t use government-controlled and designed EHRs.

2. Don’t take insurance assignment. Empower patients to file their own claims. 

3. Don’t take Medicare. See Medicare patients outside the system.

4. Don’t take Medicaid. Treat these patients at a price they can afford and that creates mutual respect.

5. Utilize inexpensive direct care or direct primary care with pretax Health Savings Accounts. 

6. Work directly for patients in all possible areas, cutting out middlemen and government.

7. Opt out of ACA, MACRA, and all the counter-productive acronymn alphabet soup programs.

8. Foster true inexpensive high-deductible plan or health sharing plans for catastrophic injuries with an HSA for doctor visits. 

9.  The above steps will make patients and physicians happy and healthy.

10. But most importantly will maximize the health and happiness of American patients.

Craig M. Wax, DO, is a primary care physician practicing in Mullica Hill, N.J. He is the host of the “Your Health Matters” radio show at Wax is also the vice president for health policy at Practicing Physicians of America and a blogger on independent practices.

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