A new health plan to take us beyond the Affordable Care Act

A new health plan to take us beyond the Affordable Care Act a

As we enter the dawn on a new era of leadership for the United States, one thing is for certain; the current healthcare system is going to face some significant challenges. At Rural Health IT, we want to interject with some insight from our perspective.

For the last fifteen years, our team has been working towards interoperable data solutions that will radically improve the healthcare system as we know it. Unbeknownst to most, the healthcare administration has been slow to react to the possibilities that technological advancements will make. The powers that be have failed to recognize the potential of improved outcomes by fundamentally changing the core of the system.

Unfortunately, Obamacare (Affordable Care Act ACA) was not radical enough in attacking the root of the problem. If we were to relate the ACA to a health injury, the ACA is like only taking a painkiller for a torn ACL, but never addressing the fact that the knee needs surgery. 

Cronyism and misdirected intentions of government officials have been holding back the healthcare revolution that we all need to happen. 

The solution going forward is to replace the Affordable Care Act (ACA)/Obamacare with a Market-Based, Fully Affordable/Responsive Healthcare System

Health care will become affordable when market-based solutions correct the worst offenses of cronyism and government interference. Here are some initial thoughts: 

A new health plan to take us beyond the Affordable Care Act

Here is our proposed health plan to take us beyond the Affordable Care Act/Obamacare

(1)   We should start our market-based health care coverage with insurance for catastrophic coverage and pay cash for service of routine care using health savings accounts (HSA).

(2)   We face a shortage of physicians in the U.S. Many medical students are from foreign countries, and these students may not practice where they are trained. So we need to look at market-based solutions, such as technology-enhanced physician/nurse practitioners, to add expertise and competition to the marketplace.

(3) The healthcare system is heavily dependent upon a pharmaceutical system of companies for treatment which is reliant on drugs and new drugs. New drugs must seek FDA approval and the process has no market-driven force dictating success. There is no system of identifying alternative treatments and success of those treatments, including homeopathic wellness solutions compared with administering drugs. Further, obtaining FDA approval is fraught with cronyism and huge expense. And most critically, patients don't choose drugs because they like the way the drugs work. Rather, doctors choose drugs because sales people chase them.

(4) Back in the 1990's, HMO's began to focus on preventive care under the premise that overall it was cheaper to pay for non-catastrophic managed care (Physicals, medicine, etc.) vs. just catastrophic coverage. This system as discussed above has gone painfully awry because of inefficiencies brought on by the economics of fee for service. It is time to marry both effective, efficient catastrophic coverage with managed care. 

(5) The process into value based managed care has begun by evolving out of fee-for-service and developing into evidenced based outcomes medicine with a preliminary use of technology. The process has been further enhanced by pay for value care using evidenced based outcomes as a standard to measure value. It requires affordable, easy to use technology to ensure success. Technology also known as health information technology (HIT) has begun to provide solutions, but the process has been marred by too much engineering and not enough focus on the needs of providers and patients. It too, like the drug companies, has been involved in a significant degree of cronyism by the government agencies and the technology (HIT) vendors. 

Solutions for a better healthcare system mean challenging the current Affordable Care Act (ACA) Obamacare

(6) The cronyism of both drug companies and HIT must be eliminated by competition and is a key factor in the replacement of the Affordable Care Act (ACA). We must have market forces incentivized throughout the health insurance and care delivery systems.   So if we combine catastrophic insurance with non-catastrophic preventive care via HSAs and pay for value, we have the beginnings of a solution.

(7) Now if we add to this focus on wellness and proactive preventive care a system of competition for patient (customer) service via physician/nurse practitioners that are 1/4 as expensive as doctors, we have the makings of a real affordable healthcare solution. However,  physician/nurse practitioners et al. are not physicians and thus must be assisted to compete with physicians. This missing medical expertise can be substantially provided by technology tools such as affordable, easy to use, interoperable analytics.

(8) This market-based combination of catastrophic coverage offered across state lines, together with patient HSAs incentivized by wellness/non-physician pay for value care programs assisted by technology enhancements, should then all be focused on prevention/mitigation of chronic illnesses, especially multiple chronic diseases and metabolic syndrome illnesses. If this combination including behavioral health (mental health) is then offered in a market efficient transdisciplinary effort across a continuum of care, we then would have an affordable system of health care truly providing for all our needs. 

Earle Rugg
Rural Health IT Corporation


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