1. Suspend all incentives
Everyone who works in healthcare, physicians, nurses, hospital administrators and insurance company employees, all agree there is too much bureaucracy. What fuels this is a never-ending quest to acquire data, which is usually redundant, irrelevant, inaccurate and often delays patient care. However, the demand for data is not only required for prior authorizations and payments, but is tied to quality initiatives and incentives designed to decrease fraud, control cost and improve outcomes. To date, it has not because the cost of collecting data to deny care or payment is higher than the payment itself. Administrative costs have skyrocketed and now make up more than 75% of the healthcare dollar. Removing incentives would immediately decompress the system, freeing physicians and nurses from unnecessary paperwork and allowing hospitals to redirect resources back to the bedside. Suspending incentives also would eliminate penalties. Don't bonus us for doing our job, but pay us fairly and promptly for the services provided. It's easy enough to try, and after a few months, we can see if the cost of managing care is worth it.
2. Prohibit all network restrictions
Network restrictions were designed by insurers to limit access to high-cost services and are marketed to employers and employees as a way to keep their premiums from rising. But networks are created by competition and collusion often with employers, many of whom are healthcare systems themselves. Ironically, those that are excluded or labeled "out of network" are often lower cost and have better outcomes. Medical services should never be restricted because it is a public trust. It's as if a fire fighter were prohibited from fighting a fire in the neighboring town. It's not safe. Access to care is one of the biggest problems in the U.S. today and has contributed to worsening outcomes especially for those in underserved communities. Along with banning network restrictions, we need site neutrality, meaning the same reimbursement for the same service, regardless of location. Where a patient receives services should be determined by risk and safety, not the employer's plan.
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3. Reward patients, not physicians or insurers
In a managed care model with capitation, insurers or physicians are incentivized to spend less than the predetermined amount allocated. But if the patient was the one who was compliant and avoided hospitalization, shouldn't they be rewarded instead? Give Medicare refunds in the form of a health savings account (HSA) that can be used to directly pay the doctor. There's no reason to take an entitlement, 2.9% of every paycheck and give it away to a third party to keep. Price transparency can only exist where there is a transparent fee for a designated service.
4. Expand HSAs to all age groups
Allow people over 65 to put money away tax-free for their future health needs. Given the increase in life expectancy and eldercare needs, it's simple common sense.
5. Repeal safe harbor antikickback exemptions for pharmacy benefit managers (PBMs) and group purchasing organizations
The price of medications and medical supplies are controlled by monopolies. The PBMs set the price of medications and are owned by insurers that stand to gain when life-saving medications are kept behind a pay wall. Likewise, consolidation of medical supplies has led to unchecked price gouging and dangerous shortages. This can be easily remedied by removing the exemption to existing laws.
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6. Restore physician ownership
A little known addition to the Affordable Care Act in 2010, prevented physicians from owning a hospital or clinic. This has contributed to the corporatization of medicine and consolidation. Board rooms are now 85% non-physicians and outcomes reflect this. Profits are routinely put ahead of patients because those without a license to practice medicine are making decisions that impact clinical care. You wouldn't feel very secure if the joint chiefs of staff weren't members of the military, yet that's precisely the kind of system we've created. It is essential to restore physicians to leadership roles and fiscal responsibility, aligning with existing laws that prohibit doctors from being employed by corporations.
7. Restrict private equity
Taxpayer money that is paid into a hospital system should be reinvested in the community being served. It should not go to fund a university endowment or Toronto's teacher pension. Funds allocated for healthcare should be used directly for patient care, ensuring that services are paid for before distributing profits to investors. Investment in medical services should be limited to public benefit corporations whose board members are required to prioritize public welfare over shareholder interests.
8. Support independent physicians
There is a significant shortage of physicians and many are dropping out or going part time because of the regulatory burdens placed upon them. In addition, network restrictions prevent independent doctors from becoming economically successful. A priority should be given to support independent practices with tax breaks to doctors who remain independent and care for Medicaid and Medicare patients.
9. Anonymize patient data
Buying and selling patient data should be prohibited. The centralization of data through cloud-based electronic medical records have created a wealth of opportunity for hackers, and has severely limited access and sharing of important clinical information. Medical records can be rendered invaluable if they are deidentified. Patients ideally should have ownership of their own data, potentially secured through blockchain technology.
10. Protect doctor-patient privacy
Like attorney-client privilege, what happens behind the examination door should remain confidential. This safeguards personal autonomy, neutralizes the impact of reproductive laws, limits liability and upholds everyone's fundamental right to control their own body.
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11. Standardize the healthcare dollar
Our current healthcare system allows insurers to operate with thousands of pricing structures, making compliance with price transparency nearly impossible. It's akin to traveling in Europe before the Euro, when varying exchange rates made it difficult to compare the cost of a hotel in Paris to one in Rome. A unified pricing system could simplify transactions and pave the way for the establishment of a central health bank where people can deposit and withdraw funds, independent of the federal budget. Such a system could eliminate $398 billion from the balance sheet and provide coverage for individuals up to 100 years old through a Medicare savings account model.
12. Put a chip in our insurance or Medicare cards
Smaller transactions could be processed immediately without the need for middlemen, streamlining the system. This straightforward approach would force the marketplace to become transparent and could potentially eliminate Medicare Part B claims entirely.
13. Separate work from healthcare
Employer-based healthcare benefits, a legacy of WWII, no longer fit modern work structures since so many people now work remotely or in gig-based roles without traditional benefits. A portable, national insurance plan – allowing people to buy Medicare off their tax return – would ensure healthcare access, regardless of employment changes. Incorporating a Medicare savings account would give individuals more control over their healthcare spending, encouraging proactive health management and providing greater flexibility. This approach could reduce administrative costs, improve accessibility and create a more transparent, equitable system.
Medical care has evolved tremendously. We live longer and spend less time in hospitals, we recover at home, take our cancer pills at home and can even see our doctors from home. The social determinants of health matter, but we don't pay our families, we pay our premiums. Time to change that thinking and build a system for where medicine is going, not where we have been.
