1: Overview / Introduction

Lots of people have been discussing healthcare in the USA: How to pay for it, Obamacare, repeal and replace, etc. We seem to have a love/hate relationship with our medical care. We like the high quality medical care that we receive and are suspicious of any legislation that would cause changes, but we also hate our present medical care. Mostly we hate how much it costs.

As of March 2017, more fuel was added to the fire with the GOP’s proposed American Health Care Act (“AHCA”), which is sometimes referred to as “Trumpcare.”

In 2003, I started a medical practice with my physician wife after a career in corporate business administration. I think that my perspective is somewhat unique, so I believe that I can offer some fresh suggestions to our national discussion of healthcare finance.

My opinion has changed over time:

When we initially started our medical practice, I thought that it should be run like any other free enterprise business. We sold the business to a hospital group in 2009, and by then I had come to be a supporter of the concept of socialized medicine.

In the years since, I have continued to read books and articles about providing medical care, and my views have continued to shift. Although I still believe that some level of government involvement is necessary (AKA “socialized” or “public medicine”), I am also a strong believer in free enterprise. At present, I believe that we need both types of involvement. I think that this suggests something like our situation with schools. We have public (i.e. “socialized”) schools, and we also have private schools. More on this later.

Disclaimer #1: It’s a BIG subject. . .

Before I go any further, I need to make an important point: When we talk about “medical care”, we’re talking about an immense subject. Medical care includes primary care doctors, surgeons, and psychiatrists. It includes dentists and eye doctors, hospitals, pharmaceuticals, medical devices, ambulances, medical supplies, nursing homes, medical research, home care nurses, electronic medical records, and the funding that pays for it all. It’s hard for me to see how one person could understand all parts of the medical industry; I certainly don’t. This subject is so huge that it’s difficult to clearly understand it in its entirety. This is especially important for legislators to keep in mind. Obamacare is certainly imperfect, and there are those who believe that it needs to be replaced. However, A poorly thought-out replacement will probably be no better than Obamacare, and possibly worse.

Disclaimer #2: . . . so there is a lot to say.

This first chapter is a brief introduction. I have a lot more to say, but I don’t want to bore everyone to tears. I plan to fill in additional details. Again though, this is an immense subject, so there is no way that I will be able to cover every detail.

Readers will undoubtedly ask questions like, “but what about privacy concerns?”, “but what about costs?”, “but what about this, and what about that?” I have answers for a lot of the “what abouts”, but certainly not all of them. Give me time. If I included everything in this initial page, then there’s no way anyone would read it all.

I welcome readers’ comments, questions, and “what abouts”.

Disclaimer #3: Not Fancy

I don’t plan on spending lots of time on fancy formatting, cute pictures, and fun animations. This will not be flashy, but I hope that it will be thought-provoking to people who are interested in the subject of improving access to medical care.

Three big problems with the current situation:

Problem 1: We seem to be doggedly focused on the concept that medical care ABSOLUTELY MUST be paid for by medical insurance. (Or something resembling insurance.) The Affordable Care Act (AKA “Obamacare”) is heavily focused on making certain that everyone has medical insurance. In my opinion, that’s one if its biggest problems: it’s based on the wrong method of financing healthcare.  Unfortunately the AHCA (AKA “Trumpcare”) seems to be based on a similar principle.

Problem 2: As stated previously, I like free enterprise. I also think that some services need to be provided by the government (i.e. “socialized”, but we don’t like using the “S” word.) The problem that I faced with my medical business is that we were neither truly free enterprise nor socialized. We lacked the benefits of free enterprise and we also lacked the benefits of being supported by the government.

Problem 3: It’s not a system. Most writings on this subject use the term “health system” or “medical system”, but I avoid using that particular “S” word when I discuss the medical industry. I would say that our healthcare industries do not generally function as a system. A system is a set of components that work together, and we lack a means of helping our medical providers to work together. A good solution would provide a means of helping the parts interact as a synergistic system.

The solutions? Consider alternatives to medical insurance. Think about socialized AND free enterprise medicine. Figure out how to make things work as a system.