People often complain that American health care is broken because we have a “free market” system. But, in fact, much of what is broken in health care in the United States is due to government intervention. The involvement of third-party payers, who are either funded or heavily regulated by the government, creates mountains of paperwork for physicians, depriving them of critical time to care for their patients.
This is one of the reasons direct primary care (CPD), a new model of health care that eliminates insurance and regulatory red tape, is spreading across the country. However, the DPC is ripe for a government takeover, which would defeat much of its purpose and not free up providers’ time for patient care.
Think of DPC as the Netflix of primary care: Patients have extensive access to their doctors for a monthly fee typically well under $ 100. They also benefit from low cost labs and wholesale drugs. Patients love CPD because it’s convenient, affordable, and hassle-free. Doctors love it too, because they can treat patients on their own terms and focus on the person in front of them rather than the health insurance paperwork.
All of these benefits stem from a single feature of DPC: no third-party payer is involved. For each transaction, the money leaves the patient’s wallet and goes directly to the provider. The simplicity of this exchange makes the patient the only person a doctor’s office needs to satisfy, which is almost unheard of in today’s healthcare system. This is a game changer for both parties.
So what could possibly go wrong? The government could hijack this model. In fact, he’s already trying to do it.
In 2018, the Centers for Medicare and Medicaid Services (CMS) issued an information request to try and implement a CPD model within Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). While they were right to recognize the potential of CPD, the reality is that CPD is the antithesis of public insurance. The very introduction of a third party payment collapses the model.
Public reimbursement of care may seem tempting to newbie CPD physicians. But they would do well to remember that government funding comes with strings attached. For example, stores that accept Supplemental Nutrition Assistance Program (SNAP) benefits, or food stamps, are subject to food and nutrition service regulations, including a laborious application process, rules Extended program integrity and other regulatory compliance requirements. By accepting Medicaid and Medicare beneficiaries, CPD physicians risk ending up with the same old burdens of paperwork again.
The only way, for example, for Medicaid recipients to gain membership in DPC would be to receive direct Medicaid cash payments that they could direct towards any health goods and services they desire. But even then, as with health savings accounts (HSAs), the government should regulate eligible spending for Medicaid cash. The chances of the CMS bureaucracy dictating what CPD doctors can and cannot do then become high.
Preventing a government takeover of a well-functioning pocket of the healthcare system requires a few ingredients. Lawmakers need to pay attention to what the market is doing right, be aware of the risk of takeover, and relentlessly oppose the gradual intrusion of an often counterproductive government.
In the case of CPD, the golden rule should be simple: legislation should never interfere with the relationship between the provider (doctor) and the payer (patient). In particular, dollars used to pay for CPD care should always flow directly out of the patient’s wallet. Keeping this principle at the forefront will effectively prevent government encroachments.
The principle can also apply to areas of health care which are already under partial government control. Reforms that remove the middleman should be prioritized over those that only alleviate the problems that government excess has already created. For example, instead of adding new treatments to the Medicare bureaucracy, lawmakers should encourage the Food and Drug Administration (FDA) to make more available over the counter. Or, instead of forcing insurance companies to cover telehealth services, lawmakers should allow patients to use their HSAs to pay for telehealth visits.
In the various iterations of the Build Back Better plan, progressive senators have come up with a plethora of expensive and expensive health items. If the latest version of the bill becomes law today, it would give Washington control over American health care to an extent that the authors of the Affordable Care Act could only have dreamed of. This includes providing Medicaid coverage to people in states that have not expanded their program – which the Supreme Court had said depended on the states – and spending $ 150 billion in taxpayer dollars on care. home.
As usual, this government intervention is justified by the fact that the market is not delivering results quickly or adequately enough. Until recently, the plan proposed to include dental, visual and hearing benefits in Medicare, although private Medicare Advantage (MA) plans already offer all of these benefits. Instead of pushing older people to enroll in master’s degree, lawmakers are using the government’s heavy hand to make original Medicare more bloated than it already is.
Make no mistake: the antidote to a government takeover of healthcare is a booming private market, one that delivers greater value to patients and allows providers to focus more on higher quality care. But stakeholders need to be vigilant, lest regulators sneak in and undermine their success.
Kofi Ampaabeng is a senior researcher and data scientist at the Mercatus Center at George Mason University.
Elise Amez-Droz is responsible for the Open Health program at Mercatus.