FIX HEALTHCARE: Low-Deductible Private Healthcare For All

Obamacare hardly needs repeal because it is collapsing of its own weight and poor design.  Millions are dropping it because of its high cost and poor coverage.  I get those notices in my office all the time.  People would rather pay the penalty.  The failure of this program is shocking.  In 2010 the Congressional Budget Office estimated that 24 million people would enroll in Obamacare plans.  That estimate is down to 10 million for 2016, missing the target by 58%!

Then there is Medicaid.  It provides poor quality healthcare, most doctors don’t take it, and it is busting federal and state budgets. In 1999 Dr. Fox published a research paper that found that children with asthma who are on Medi-Cal do worse than children with private health insurance and, surprisingly, worse even than children with no health insurance at all! And, for the taxpayer, the cost of Medi-Cal was almost double that for private insurance.  Similar results were found for all other diagnostic groups among children. Medi-Cal: not good for kids, not good for taxpayers.

In the prominently reported Oregon Medicaid study, where half of the study population was put on Medicaid and the other half remained uninsured, there was no health benefit to being on Medicaid.  This is important because about 85% of those previously uninsured who are now covered by Obamacare are being covered by the expansion of Medicaid. 

Then there is the VA healthcare system, a perennial scandal.  Then there is Medicare.  Under Obamacare, Medicare is going to get hit with three quarters of a trillion dollars in cuts to pay for Obamacare, conveniently put off until President Obama leaves office.  For those who don’t want anyone to touch their Medicare, well, it has already been not just touched but clobbered.  Medicare as we know it is history, a zombie plan, sacrificed to fund Obamacare.  For those with employer-based coverage, their costs are rising because of Obamacare taxes and shifting of costs from government-insured patients to those with private insurance.

Dr. Fox Providing Free Medical Care To A Child On His Mobile Medical Clinic In 2004

My proposal is to replace all these government health programs, and many others, with a government-funded health savings account for everyone sufficient to pay for a basic low-deductible managed care health plan of their own choice, like Kaiser.  There would be no pre-existing condition limitations.  The amount of the government-funded healthcare credit would increase with age.  People could also put additional tax-free money in their health savings accounts up to a limit.  People could also keep their employment-based plans if they want to by applying funds from the health savings accounts to those employment-based plans, but any employer contributions to those plans would no longer be tax free.  That would allow them to upgrade their basic health plan to a better one by using their health savings account to help pay for it.

Seniors who want to keep their traditional Medicare could do so but they might want to switch to the new government-funded health savings account because the Medicare Trust Fund will run out in a few years, requiring even deeper cuts in regular Medicare then.  Veterans could either keep their current VA benefits or opt to use their government-funded health savings account to buy a plan of their choice.  Veterans would get a larger government contribution to their health savings accounts, sufficient to pay for most (three fourths) of the managed care plans offered in that market.

We can pay for this by getting rid of all the existing wasteful government health plans and limiting the federal tax deduction for private health plans.  This will not increase the federal debt. 

I would also scrap the wasteful federal requirements for electronic health records and ICD-10 coding.  Doctors need more face-to-face time with their patients and less time filling out forms that hardly anyone looks at.  Patients who really want electronic health records can go to doctors who offer them.  We need more choice in healthcare, not more costly mandates and penalties.