Friday, November 14, 2008

Talking Sense

Ben Brewer, MD lays out his proposal to treat our health care crisis:
Looking at the way the government is doling out money these days, I have a proposal to help improve people's health and our system of care. What if the government gave each person $365 of their tax money back to be spent on primary health care?

That amount could be paid directly to each person's primary care doctor for a year's worth of services. Imagine if everyone in America could contract privately for medical care for themselves with a primary care doctor without government or insurance company red tape.

The patient would choose the doctor. The basket of services would be predefined, and the price would be locked in for a year, paid as a monthly subscription like cellphone service or movie rentals.

Money spent that way would cover a lot of preventive health, office visits, management of chronic diseases, email contact with the doctor, and after-hours advice. Make it tax deductible for individuals as well as businesses.

Doctors like the idea of universal coverage, but don't like the idea of unfunded mandates, like some programs to improve quality that cost physicians more to implement than can ever be recouped.

They don't want to be conscripted into a national program that pays them less than their costs. They don't see Medicaid or Medicare for all as solutions because those systems skimp on primary care and impose crushing paperwork and regulation.

But it seems to me that it is time to get beyond the argument of whether health care is a right or a privilege. We need to do something practical to bring affordable, basic health care to working people. Primary care isn't cheap, but it's less expensive than any other option.

We have had a financial stimulus package. My patients spent their $600 checks on $4 gas to get to work. A better and longer-lasting use of the money would be a health-care stimulus package.

The attraction for the doctor would be no billing hassles, no massive insurance coding system, no extensive overhead, and no bogus pay-for-performance schemes that cost more than they save. The infusion of money would also bolster primary care and might make it more attractive to new doctors over the long haul.

For primary care doctors, a $1 per patient per day would make for reasonable income from a smaller group of patients than most of see now. Patients would get more time with their doctor when they need it. There would be fewer office visits just so the doctor can get paid for giving advice.
Is his idea so far fetched?

I don't think so.

And yet, make no mistake, the push back will be substantial from those who benefit from the bureaucracy.

I am aware that even large physician groups such as ours, already equipped with the latest electronic gadgetry to track pay-for-performance initiatives, in their zest to go "all in" on the concept to earn their "gold stars" on the government's pitiful quality website (which is rarely consulted by patients, by the way), failed to cover the cost of implementing the initiative its first year. It's been just too many personnel, spending too many precious resources to gather data of limited value, rather than applied to the delivery of health care. (If you want to see just how bad it's become, check out the specifics over at the Happy Hospitalist.) This initiative has been a colossal failure in my book, but sold lock, stock and barrel to the populous by the policy wonks on Capital Hill.

So I can hear it now: "What will happen to all of those people paid to collect the data? They might become unemployed at this time of our colossal economic downturn! Our unemployment numbers will go up! We can't have that!"


We cannot afford NOT to make a significant change to the way we do health care today. I am convinced as Americans consider the options ahead of them, that they'll make the right choice and realize the consequences if they don't. Dr. Brewer's proposal makes a lot of sense.

After all, managing our own cash is looking pretty good right now.



The Happy Hospitalist said...

Dr Wes. That is a fascinating proposal by Dr Brewer, considering it sounds exactly like my proposal that I blogged about one year ago exactly on November 13th, 2007. My proposal was for $360 per person per year in federal subsidized tax credits ($30/ month) towards primary care. I called it my Primary Care Initiative. Go check it out. The two proposals are identical.

My 125 Billion Dollar Experiment


Reblogged about it three days ago in response to Dr Centor's comments

Makes you wonder who's reading who. Regardless, the fact that My Idea/Dr Brewer's idea (which sounds exactly like my idea) made it into the wall street Journal is fantastic.

What's your take Doc?

DrWes said...


I recognized this, too. I liked your idea then, and I still like it now. Relative to my cable TV bill (which costs more than twice as much - and for WHAT?), it seems to make a whole lot more sense.

Anonymous said...

For a little less than $2 a day and a panel of only 500 patients, I would convert my practice to home visit/jobsite visit only. I could afford to offer secure online chart access and offer basic screening labs and yearly one hour complete physical exams with EKG. People need to realize they are getting ripped off by the insurance companies and that their quality of care could be fantastically improved.

DrWes said...

Anony 09:18 and Happy-

The challenge to this approach will be finding enough generalists to keep up with the demand these days...