Doctors are no different than anyone else in spite of us often being placed on pedestals. The altruistic thoughts that brought many of us into the healthcare field became more and more tempered as time went by and outside forces began to
dictate how, when and where we could care for our patients. I can still remember "trading" my services for something like brickwork, hunting lease access, housepainting, or yardwork. People took pride in their ability to take care of themselves and their
families. If a person had insurance, they would pay for services up front and we would sign the forms for them to mail in. Then we started filing the forms for our patients as a way to "provide" better care than our competion. Next we began taking
insurance assignments to minimize the out-of-pocket expense. Since that out-of-pocket expense was no longer a factor in seeking treatment, more sought our services. Some doctors soon realized that since the patient really didn't know what the fees
were, and even more-so didn't care since the "insurance company" paid for it, fees began to go up. As the insurance companies tried to get a grasp on escalating fees, "norms" or average fees were established for an area. In order to get properly re-imbursed,
almost all of us tried to stay in the magic "75% percentile" range in order to be sure we stayed ahead of the inflation curve of the 1980's, knowing that next year's re-imbursements would be based on this year's charge schedule or percentile ranking.
Confusing? For everyone, including the patient, who still did not really understand the process since the insurance company took care of everything. As with any "house of cards" the inevitable was about to happen. As technology began to out-strip our
ability to pay for it, the demands for hi-tech services went up, costs again went up, and the outcry from un-insured individuals finally reached the ears in Washington. Reason was removed from the equation in exchange for expedience and political gain.
So just what can be done to solve the problem now that we have raised a generation of doctors who expect to get paid in cash for everything they do, a generation of recipients who have never understood the concept of fee-for service, plus an ever increasing
pool of individuals that feel they are "entitled" to healthcare as well as a good life-style simply as a birthright? The current proposals are not sustainable or capable of providing the hightech, timely care we in the United States have come to expect.
In order for one to grasp this concept, we must remember that most professionals in this day and time simply want to get "something for something" i.e. if I provide a sevice, what can you give me in return. At present there are over
one MILLION healthcare providers in the U.S., many of whom participate in medicare and medicaid. However, that number is declining even while the healthcare law (Obamacare) is seeing an increase in the number of medicaid/medicare recipients. Indigent
care is paid for by increasing hospital costs billed to those with insurance to the point that many young people don't bother with insurance since the word on the street is "they have to take care of you!" Add in the illegal immigrants that show up in ER's
and the problem is compounded. What if there was a way to provide 75 BILLION dollars worth of free health care to indigent people, the very people Obamacare was supposed to help? There is a way, it will just take some forward thinking members of
congress. Suppose a tax credit were given to any healthcare provider, a $50,000 credit for $75,000 worth of actual patient care. In order to be elgible for the tax CREDIT (remember, one must have at least that much tax liabilty to get a credit) , the
provider also must participate in medicare and medicaid. Now let's provide a National Health Care card to eligible individuals based on need and relative income. Those that want a card MUST file an income tax, in other words, MUST take some responsibilty for
their care by participating in a system to monitor eligibility. This card would provide up to $3,000 in free care at any clinic or office (or hospital) during REGULAR business hours as opposed to the frequent non-emergent visits that often clog our ER's at
midnight. The end result would be better care in a more timely matter. The individual could decide how they wanted to use the available funds each year (minor surgery, diagnostics, podiatrist, eyeglasses, dental care, etc.) or if they wanted to carry
them over for up to 36 months if they needed elective surgery. If there are now 25 million in need of care, this is 75 BILLION in care that would be availible at a cost of 50 Billion in lost "tax" revenue. Now some might say "those rich doctors
don't deserve any more tax breaks", but let's remember they are providing a service at NO CHARGE to the taxpayer who would otherwise foot the bill for indigent care! This does not even take into account that the care provided is likely to be better and in
a more timely fashion in an office rather than ER environment. Another consideration is that if the 50 Billion were collected as tax revenue, less than 40% (20 Billion) would ever actually be used to provide care. So which is a better "bang for the buck" ?
$75 Billion in actual provided care through this plan, or $20 Billion in care through existing methods, much of which goes to ER's in the middle of the night, the most expensive time to be seen? The choice seems obvious.
The next question that
arises is "what about catastrophic injuries etc.?". In order to fund a national catastrophic illness/injury insurance pool, I propose a national 1/2 cent sales tax, the only fair tax for all involved. Everyone should have some inward sense that
they are contributing to their own care. This is called "self-worth", a concept we have been taking away from the poor for a long time. One has to wonder if this is a subliminal way of making the wealthy or more advantaged people, or even those with a
"high moral conscience", think they are superior. Has that concept escaped those who insist on continuing certain entitlements ? I can remember doing medical missions work in Central America when as many as 500 people would line up for "free"
care. Most did not need any care and came for the free medicines (ibuprofen, aspirin, antidiarrheals, antacids etc) we provided. I finally put up a sign "cost is $1 to see Doctor" and the number waiting dropped to 200...but they REALLY needed to see us!
In summary, a Tax Credit plan for particpating health care providers would accomplish the following:
1) Provide necessary care to those in need in a timely fashion, primarily in an out patient setting.
2) Return many health care providers back to the medicare/medicaid rolls they are now fleeing.
3) Free up our overcrowded ER's making room for those truly needing emergent care
4) Save the tax payer the cost of funding a system doomed for failure.
5) let everyone have "skin-in-the-game" with the 1/2 cent sales tax.
This idea is certainly not the answer to all the problems with
healthcare, but at least it addresses the indigent care issue in a simple, straight forward way, eliminating much of the bureaucracy and waste.
My last question is "What are your thoughts to improve our healthcare system? " When working on a solution,
consider something that will continue to insure our nation's well-being as well as encouraging many of our best and brightest young minds to enter the healthcare field.
Dr. Dennis Spence