Clinicians Must Cure “Patient Healthcare” Politicians Never Will

Clinicians feel as though they are drowning . . . because they are! Between complying with time-wasting federal regulations, complying with HIPAA as well as ever-changing hospital policies and procedures, plus the entire Byzantine billing process, who can keep up with the literature, study a patient’s medical history, or find time to talk with a patient?!?

Yet here I am piling another task on to a plate already over-flowing. Doctors and nurses need to focus on the sickest patient of all, named U.S. Healthcare System. The current attending physicians—Congress—have been treating this patient for more than 50 years. In reality, they have been poisoning the patient Healthcare for 50 years.

Consider what their treatments have done. In 1960, the U.S. spent 5% of the gross domestic product (GDP) on healthcare. By 2026, when Medicare goes broke,1 we will be spending 20% of the GDP, $5.5 trillion,2 which nearly equals the entire 2018 GDP of Japan, $5.2 trillion. Close to half of all U.S. healthcare spending produces no care–it goes to federal BARRC: bureaucracy, administration, rules, regulation, and compliance.3

According to a Merritt Hawkins survey,4 the average maximum wait time in 2007 to see a primary doctor was 100 days: 10 years later, with the Affordable Care Act implemented, it was 176 days. Before Obamacare was instituted, the national acceptance rate by physicians of new Medicaid patients was 74%. Now, it is 55%.

Patients are asking why they can’t get care, especially timely care. The answer—the “diagnosis”—is cancer. Cancer is consuming both the money for care and physicians’ time to care for their patients. The location of the primary malignancy is Washington
and it has metastasized diffusely.

There are literally innumerable examples to prove that the cancer in healthcare is federalization. Before describing an effective cure, I will offer three such examples.

Rhode Island and Montana have the same populations, one million residents each. Rhode Island has 5146 physicians within its 1212 square miles. There are three world-famous medical centers within less than one hour’s drive of Providence, Rhode Island’s capital city. Montana has 1100 doctors scattered over 145,000 square miles. From the capital city of Helena, the nearest major medical and trauma center is more than eight hours away, in Salt Lake City, assuming the roads are passable. Despite these differences, Washington mandates a one-size-fits-all approach in these two very different states.

According to Section 1801 of the original 1965 Medicaid law, programs are supposed to be “administered by the state.” Yet federal mandates administer (control) all state programs—Washington decides where state money goes, not the state residents through their legislators.

With federal healthcare comes federal bureaucracy and its insane complexity, such as the ICD–10 code book. There are approximately 1400 ailments and injuries that befall humans. The code book to bill for care contains more than 68,000 codes, such as W55.21 (bitten by a cow), W61.33 (pecked by a chicken), V00.01 (pedestrian on foot injured in collision with a roller blader), and Y92.146 (injured at a swimming pool within a prison).

The cancer in healthcare is a bipartisan affair. Both Republicans and Democrats are guilty of poisoning the patient known as Healthcare. To be fair, the Democrats’ Obamacare doubled the dose of poison. Their Medicare-for-All plan, H.R. 1384, would put healthcare in a coffin.5

Washington will never cure the patient Healthcare. Expecting Washington to fix healthcare is like waiting for cancer to cure cancer.6 Someone else has to do it. Who will? The only power greater than Washington is We the People, or as I like to write, We the Patients. They need guidance from their clinicians. We understand better than anyone else that sooner or later, everyone is a patient. Republican, Democrat, or Independent; whatever your skin color or religion; no matter where you reside; and regardless of income level—eventually, everyone needs medical care. We the Patients are the one consistent stakeholder. We the Patients have the power—if We will use it.

Doctors know how to cure a patient, any patient, whether human, animal, or sick system. Identify the root cause and cure that. If a patient has an infection, you give an antibiotic specific to the infectious agent. If a patient has a blocked coronary artery, you unblock it. If a patient has cancer, you cut it out, even if the patient is named Healthcare and the cancer is Washington.

To cure patient Healthcare, excise Washington. Return freedom and autonomy to We the Patients. Release the free market that made this country great. Restore the direct connection between doctor and patient.

Return Freedom

The United States was founded on the singular principle of freedom—freedom from control by a central authority and from the constraints of a structured class system. With that freedom come a variety of choices, the potential for unlimited individual success, and personal responsibility.

In 1776, we freed ourselves from a tyrannical aristocracy. Today, by accepting government entitlements, we are drifting back toward tyranny, this time by the professional political class.

Americans should be free to choose their care providers, free to decide their own medical care, and willing to accept the consequences of their choices. Americans should be free to control their own spending without a third party, whether government or insurance, dictating where patients’ money goes and how much money they expend, supposedly on patients’ behalf.

U.S. healthcare should be free from federal control, not only because of Washington’s poor track record but on legal grounds as well. The Tenth Amendment to the Constitution states that Washington should not have “power” over healthcare. “The powers not delegated to the United States [federal government] by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.” Healthcare was not delegated to the federal government. With five doctors as signatories to the Declaration of Independence and many more physicians as members of the Constitutional Convention, the founding fathers did not simply forget about healthcare. Washington was never supposed to be in charge of healthcare.

Release the Market

U.S. healthcare has arrived at an unenviable state: spending too much and getting too little. In 2018, the average American family spent $28,166,7 39% of their total income, on healthcare, mostly for insurance premiums, which more than doubled due to Obamacare.

Both our veterans8 and Medicaid enrollees9 are experiencing death-by-queuing: dying while waiting in line for care. And when Medicare goes broke by 2026, seniors won’t be able to get hospital care.1

Clearly, Americans are spending more on healthcare and getting less care despite decades of Washington fixes. With any centrally controlled market, whether for services such as healthcare or goods such as bread and soup, costs invariably rise while quality and availability fall. Two recent examples are the now-defunct U.S.S.R. and the failing nation-state of Venezuela, both of which had centrally determined production, prices, and wages; prohibition against private property, and elimination of profit motive, just as proposed in Medicare-for-All, H.R. 1384.5

Because they are paying out of their own pockets, buyers have a powerful incentive to economize.

The United States has not had a free market in healthcare since the 1930s, when third-party payers were developed: government and insurance (supported by federal mandates). A free market depends on the direct connection of a buyer (patient) with a seller (service provider or manufacturer). The buyer decides whether to buy or not, how much to pay, and whom to pay. Because they are paying out of their own pockets, buyers have a powerful incentive to economize. Sellers have to compete for buyers’ dollars based on price and quality. If prices are too high or the quality is not satisfactory to buyers/consumers, the seller fails to sell his products or services.

In a free market, there is constant downward pressure on prices, competition to produce the highest quality, and a compelling reason not to spend. When a market is centrally controlled, as U.S. healthcare is today, the exact opposite occurs, as Americans have experienced. Prices rise to unaffordable levels and then keep rising. Competition is fierce, but for contracts, not service to patients. Access to care goes down and down. As providers are devalued, their payments degrade. The incentive is to increase spending—on BARRC rather than on patients, on bureaucrats rather than doctors.

The solution to healthcare’s death spiral starts with cutting out the cancer that is Washington. Obviously, Congress will resist reducing its own power. Only We the Patients can make this happen. Doctors need to explain to their patients that healthcare has cancer and that there is a simple cure so Americans can get healthcare their way: StatesCare. 10

StatesCare

Removing Washington from healthcare—StatesCare—brings the decision about healthcare down to the state level, where representatives are in constant contact with their constituents and much more responsive to you and me. (Contrast this with our Congressional representatives.)

If 28 million Texans want market-based medicine,10 if 6 million residents of Washington state want their version of universal healthcare,11 and if 39 million Californians want single payer,12 by what authority does the District of Columbia deny 73 million Americans the right of self-determination? While the evidence leads this author to conclude that single payer is an unwise choice,13 my opinion should count only in my home state. Let the people in their states decide—it’s that simple.

Excising Washington from healthcare also would remove its complex and costly bureaucracy.

When a resident of one state is visiting another state and needs care, reciprocal arrangements should be in place. This is a matter of negotiation that Americans would expect their states to accomplish. Furthermore, if a resident in one state strongly objects to the system chosen there, he or she is free to move elsewhere. In fact, people are already relocating because of state tax rates.14

Excising Washington from healthcare also would remove its complex and costly bureaucracy. Evidence-based estimates of the cost of the federal bureaucracy indicate more than 40% of healthcare expenditures go to BARRC. In other words, because the United States spent $3.5 trillion on healthcare in 2018,15 $1,400,000,000,000 worth of patient care was taken from the American people to pay for BARRC.

With StatesCare, Americans can recoup most of that money and either leave it in taxpayers’ pockets or spend it on doctors and nurses instead of wasting healthcare dollars on bureaucrats (see Figure 1).

Figure 1. Growth of physicians and administrators 1970 through 2009. (Data from Bureau of Labor Statistics, Statistical Abstract of the United States, 91st to 109 editions; National Center for Health Statistics (NCHS); and Analysis of Current Population Survey (CPS) of the Bureau of Labor Statistics, 1970-2010 by David Himmelstein and Steffie Woolhandler, Hunter College, New York City College.)

Restore the Doctor–Patient Connection

The people in their states should decide the best healthcare for them. Doctors should urge restoration of the direct doctor–patient relationship without a third party in between, and release of the free market.

If Americans want to be free to make their own medical and financial decisions, they must reject entitlement in favor of personal responsibility.16 If We the Patients want doctors who know them by name, who have studied their medical history, who will see them tomorrow, not in six months, and who have time to talk with them, then patients must control their own spending.

High-deductible catastrophic insurance? By all means. Insurance or government bureaucrats making medical and financial decisions for patients? Absolutely not! Patients should have large HSAs that they control with no time limit for use. Patients would shop for providers and care, and pay “cash” from the HSA. Providers would compete for buyers’ (patients’) dollars. Just like buying a car, patients would require not just affordable prices but also positive outcome metrics, in forms they can understand. That is our job, if we want patients to purchase our services.

State residents should decide their own healthcare.17 Doctors need to acquaint the public with the advantages of market-based medicine and the advantages of restoring the direct doctor-patient connection with no third party in between. It is likely that people would want a safety net for medically vulnerable Americans. There are viable options, including high-risk pools and state-supplied HSAs.6

Clinician: ask your patients if they would choose to continue paying more than $28,000 to insurance companies and get whatever care some bureaucrat approves, or put the $28,000 in an HSA, buy high-deductible insurance, and pay for care and insurance out of the HSA?

Healthcare is not inherently complex. In fact, it is simplicity itself, or should be. A patient makes a contract with a doctor. Doctor provides service. Patient pays for service. Period. It is the incursion of the third party as payer and, therefore, decision-maker that disconnects patient (buyer) from doctor (seller).18 Such disconnection turns a simple contract into a massive coding, billing, review, and compliance structure of rules and regulations. The process of providing care has become intricate, maze-like and incomprehensibly complex, but it need not be. Simply reconnect patient and doctor.

Conclusion

The patient Healthcare System has cancer.6 The primary lesion is located in Washington but has metastasized everywhere. The cure for this cancer is to excise Washington and its ancillaries from healthcare. Let the people in their states decide what healthcare structure they want.

Exhortation

When I discuss the ideas I have expressed in this article with other physicians, they generally concur. When I urge an active, leadership role in fixing healthcare, the same doctors demur. “We have no time! Our patients need us now. We simply can’t do more.”

The best response is a paraphrase of Rabbi Hillel’s words from the book Ethics of the Fathers, written shortly before the Common Era. President Kennedy also emphasized this aphorism. “If not me, who? If not now, when?”

I exhort all clinicians to arm yourselves with the evidence and proofs in my book Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.6 Then, and more important, encourage patients to read the book. Only a groundswell from the American people can force Washington to relinquish its tight grip on healthcare and return authority where it belongs: We the Patients.

References

1.    Mnuchin SR, Acosta A, Azar A II, Berryhill NA, Verma S. 2018 Annual Report of The Boards of Trustees of The Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2018.pdf. Accessed November 2019.

2.    Beaton T. National healthcare expenditures expected to reach $5.5T by 2026. Healthpayerintelligence.com. February 16, 2018. https://healthpayerintelligence.com/news/national-healthcare-expenditures-expected-to-reach-5.5t-by-2026. Accessed December 10, 2019.

3.    Waldman D. The Cancer in the Healthcare System: How Washington Controls and Destroys Our Health Care. Corpus Cristi, TX: Strategic Book Publishing and Rights Agency; 2015.

4.    Merritt Hawkins Team. Physician appointment wait times & Medicaid and Medicare Acceptance Rates. MerrittHawkins.com. 2017. www.merritthawkins.com/news-and-insights/thought-leadership/survey/survey-of-physician-appointment-wait-times/. Accessed March 4, 2018.

5.    Waldman D. Effect on Patient Care H.R. 1384 Medicare for All. Texas Public Policy Foundation. 2019. https://www.texaspolicy.com/right-on-healthcare-effect-on-patient-care-of-h-r-1384-medicare-for-all. Accessed January 2020.

6.    Waldman D. Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine. Albuquerque, NM: ADM Books; 2019.

7.    Paavola A. $28k: The average price a family of 4 will spend on healthcare in 2018. Beckers Hospital Review. August 22, 2018. www.beckershospitalreview.com/finance/insured-family-of-4-will-spend-average-of-28k-on-healthcare-this-year-plus-6-other-facts-on-healthcare-costs.html. Accessed December 2, 2019.

8.    VA Office of Inspector General. Review of alleged mismanagement at the Health Eligibility Center. Report: September 2, 2015;14-01792-510. https://www.va.gov/oig/pubs/VAOIG-14-01792-510.pdf. Accessed December 2019.

9.    Horton N. Hundreds on Medicaid waiting list in Illinois die while waiting for care. Illinois Policy. November 23, 2016. www.illinoispolicy.org/hundreds-on-medicaid-waiting-list-in-illinois-die-while-waiting-for-care-2. Accessed August 10, 2018.

10.   Waldman D. California wants single payer and Texas wants free market — say hello to ‘StatesCare.’ The Hill. March 10, 2017. https://thehill.com/blogs/pundits-blog/healthcare/323424-california-wants-single-payer-and-texas-wants-free-market-say. Accessed May 15, 2018.

11.   My Northwest Staff. New bill looks to clear path for state universal health care. Mynorthwest.com. February 14, 2019. www.kiro7.com/news/local/new-bill-looks-to-clear-path-for-state-universal-health-care/920511980. Accessed December 5, 2019.

12.   Tullus P. Can California go single-payer? The American Prospect. May 10, 2017. https://prospect.org/health/can-california-go-single-payer/. Accessed January 10, 2019.

13.   Waldman D. Single Payer Won’t Save Us. Gatekeeper Press: Columbus, OH; 2016.

14.   Williams J. Americans continue their march to low-tax states. The Hill. February 12, 2019. https://thehill.com/opinion/finance/429623-americans-continue-their-march-to-low-tax-states. Accessed November 10, 2019.

15.   Daily Briefing. How much did the US spend on health care last year? $3.5T, according to CMS. Advisory Board. February 15, 2018. www.advisory.com/daily-briefing/2018/02/15/health-care-spending. Accessed February 15, 2019.

16.   Waldman D. Americans can be entitled or free—but not both. The Hill. February 18, 2018. https://thehill.com/opinion/healthcare/374435-americans-can-be-entitled-or-free-but-not-both. Accessed June 15, 2019.

17.   Waldman D. A doctor’s straight talk: America, your health care is not a federal responsibility. Fox News. January 4, 2017. www.foxnews.com/opinion/a-doctors-straight-talk-america-your-health-care-is-not-a-federal-responsibility. Accessed January 15, 2018.

18.   Waldman D. Thinking systems need systems thinking. Syst Res Behav Sci 2007; 24, 271-284.