Building a healthcare finance scheme Discussion

M eaningful healthcare reform respects the pa- tient–physician relationship. No current plan meets this basic criterion. More troubling is the fatal flaw every current proposal includes:

health insurance. Building a healthcare finance schema on a foundation of health insurance is a mistake. Let’s own it.

It is surprising how each of us overlooks the basic eco- nomic premise of health insurance. Insurance, in essence, is paying a private company on a bet that we won’t need its product. Yet every person falls ill at some point in his or her life. Like water and food, healthcare consumption is a 100% guaranteed life expenditure. Worse still, health insurance companies have done a phenomenal job of obfuscating the small but profound fact that their product is completely unnecessary to improve our actual health. Premiums will rise ad infinitum because, frankly, as private companies, they can charge whatever they like. How did we all get it so wrong? And why is it so hard to change?

No individual sector is free from blame. Hospitals and pharmaceutical companies built corporate finance models on the same shaky ground as health insurance companies that have a vested interest in pleasing their shareholders. Physicians intensified the disparity by going along with these schemes and, worse, built the CPT codes and “pro- cedures reimbursed more” mentality that promotes stigma regarding mental health issues and creates discord among specialties. Patients seem to have forgotten that “there’s no such thing as a free lunch” and that nothing is “owed” to us as individuals except for those items granted by the

Bill of Rights and U.S. Constitution (which does not directly mention healthcare).

I first noticed the gaping holes in healthcare finance during my third year of medical school, and they have only intensified since then. Three years after finishing residen- cies in pediatrics and psychiatry, my burnout was palpable. Headaches, depression, and panic attacks ensued. At 34 years old and $200,000 in debt, I seriously contemplated returning to my college job as a pharmacy tech.

After years of fighting insurance companies and stress- ing over documenting visits, I resigned from my staff psy- chiatrist position at a major children’s hospital to heal. Two solid months of soul searching, talk therapy, and social affirmation led to personal breakthroughs and a profound realization regarding healthcare’s actual issue: we have millions of quality, compassionate healthcare providers that patients cannot access. Not content with the status quo, I made it my personal mission to change our $3.2 tril- lion self-inflicted boondoggle.

The “fix” starts with understanding a health visit. During a private interaction, a patient asks a question, the provider gives an educated guess, and the patient pays the provider for his or her time, expertise, and place (if applicable). The fact that the United States found a way to squeeze federal government, insurance companies, risk pools, Big Pharma, bureaucracy, hospitals, and politics into a basic two- party private conversation is a testament to our “made in America” ingenuity. The result is an infuriating quagmire

Novel Healthcare Reform Starts with Owning Our Mistakes Brian J. Dixon, MD* Building a healthcare finance scheme Discussion

Faulty logic regarding the role of health insurance in healthcare access has led to implausible healthcare reform ideas. Recognizing that the ideal approach to healthcare access is to restore and support the direct patient–physician rela- tionship, an independent child psychiatrist reimagines the healthcare finance model, establishing patient–physician accountability as the foundation. Creating “citizen-shareholders” eliminates perverse incentives, promotes universal access to quality affordable healthcare, and restores personal responsibility in health- care management.

KEY WORDS: Citizen-shareholder; ACA; Obamacare; autonomy; burnout; health insurance; VA; Medicare.

*Founder, CEO of Together Forward, PO Box 11886, Fort Worth, TX 76110; e-mail: health@togetherforward.org; website: www.togetherfoward.org. Copyright © 2017 by Greenbranch Publishing LLC.

82 Medical Practice Management | September/October 2017

www.greenbranch.com | 800-933-3711

of increasing health costs, worsened income inequality, and social unrest that now threatens our very democracy.

Unsurprisingly, every mainstream solution offered by a nonphysician violates the sanctity of the health visit. Presi- dent Obama’s Affordable Care Act (ACA), Secretary Clin- ton’s Expanded ACA, Senator Sanders’ Medicare-for-all, President Trump’s “Across-State-Lines,” Representative Ryan’s “A Better Way,” and Senators Cassidy and Collins’ Patient Freedom Act all wreak havoc on direct account- ability between patient and provider. In fact, the whole notion of “health insurance” is a red herring, because there is no reason (or way) to insure against something that has a 100% chance of happening. The single-payer system inserts a government entity between the patient and physician, which is inextricably worse than our current situation (see the Veterans Administration as an example.) Instead, plausible, viable solutions must have direct patient–pro- vider accountability as the basic foundation of healthcare finance reform.

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