The Patients’ Choice Act It is time to publicly admit that the health care system in America is broken. Costs are rising at an unacceptable rate—more than doubling over the last 10 years, which is nearly four times the rate of wage growth.1 Too many patients feel trapped by healthcare decisions dictated by HMOs. Too many doctors are torn between practicing medicine and practicing insurance. And 47 million Americans worry what will happen to them or their children if they get sick.
Although our health care system has major problems, it also has major potential. We have the best doctors in the world…the best scientists in the world… the best hospitals in the world. About 70 percent of Nobel Prizes in medicine come from the United States, and five of the six most important medical discoveries over the past 25 years are American.2 Now America needs the best health care system in the world. The Patients’ Choice Act would remove the barriers that separate Americans from high-value health care by enhancing individual purchasing power and creating rational government rules.
We can make the current system work by returning to certain core principles. Protecting the doctor-patient relationship and ensuring patient choice is fundamental to any reform. Prioritizing the needs of patients and doctors must be fundamental. Creating a market that plays by the rules is the most powerful force to increase quality and make health care more affordable. And increasing the association between patient responsibility for payment and quality of outcomes would vastly improve accountability.
While health care is not a commodity in the traditional sense, patients would benefit from having more information on quality and costs. Rather than patients appealing denials of care or waiting to see a health care provider, insurance companies and doctors should compete for patients. Universal access to affordable health care for all Americans should be guaranteed. Congress should enact a comprehensive solution that will make our healthcare system work for every American every time.
The Patients’ Choice Act would give every American the opportunity to choose the health care plan that best meets their individual needs. It will utilize state-driven exchanges to facilitate real competition between private plans and give Americans—for the first time—a choice of health care plans. Insurers should be able to provide packages which offer care for patients suffering from chronic conditions. Unlike the government-driven change being advertized today, it will truly achieve portability so that workers can take benefits with them when they change jobs. Rather than Washington and company CEOs, the Patients’ Choice Act puts patients in control. This solution will actually fix the incentives in the health care system so that health providers and insurers provide higher quality plans at lower cost. This is the kind of change America’s health care system needs.
In solving our health care crisis, Americans already know that government will not work. Washington and state bureaucracies already control more than 59.8 percent of health care spending.3 Private health plans are influenced heavily by government price controls and payment formulas. But programs run by the government are plagued with waste, fraud, and abuse. More than $60 billion is lost each year to Medicare fraud.4 And over 10 percent of Medicaid money—over $32 billion—is spent improperly each year, with that number reaching 40 percent in some states.5,6 And tragically, patients in government programs suffer worse health outcomes than patients in plans like the BlueCross/BlueShield standard option.7 Why does our health care system fail so many patients? The answer begins and ends with government intervention.
Core Concepts Emphasize Prevention
Five preventable chronic conditions consume 75% of our health spending and cause two-thirds of American deaths. Investing in prevention will lower long-term costs and ensure Americans live longer and happier lives. Solutions should change “sick care” into “health care.”
The status quo regulation of the insurance market does not provide incentives for insurance companies to cover chronically sick patients and many sick patients are unable to afford premiums. Businesses must play by transparent rules and compete for patients’ business. The market must work for every patient every time. Patients should have convenient and affordable options, and they should have control of those options. Doctors, hospitals, and nurses should be more involved in patient-centered care.
Guarantee Choice of Coverage Options
Patients should be able to choose from a variety of private insurance plans. The federal government would run a health care system—or a public plan option—with the compassion of the IRS, the efficiency of the post office, and the incompetence of Katrina. We cannot entrust the federal government to deliver high quality health care to every American. All Americans have a right to personalized and individual health care that will meet their unique needs.
Patients already in government programs deserve a human approach to their health benefits and fewer bureaucratic barriers. Individuals struggling to purchase their own health insurance deserve the same tax breaks as Americans working in Fortune 500 Companies. Medicare beneficiaries deserve delivery choice when selecting between health benefits.
Fairly Compensate Patient Injuries
Patients should have the right to fair legal representation and fair compensation for tragic, inexcusable mistakes in the health care field. However, today’s legal system serves the self-interest of personal injury lawyers, drives up costs, and delays justice. Science-driven and results-oriented change is needed today.
America spends more than $2.4 trillion on health care every year—16.6 percent of our gross domestic product.8 On a per capita basis that is nearly twice what other industrialized nations spend,9 and it is 25 percent more than Switzerland, the next biggest spender, spends. Entitlement program liabilities threaten our nation’s long-term fiscal stability. Future generations of Americans will have to pay $36 trillion in new taxes to keep the promises made by today’s politicians for the Medicare program alone. Without reforms, the Medicaid program will spend at least $4.9 trillion over the next 10 years.10 Washington has already proven we cannot spend our way out of this problem. Innovative solutions should focus on making health care more affordable, especially when cost is a major barrier to access.
The children covered under government health care programs today will face future tax increases in order to pay the $36 trillion unfunded liabilities in the Medicare program alone. Medicaid fraud and mismanagement waste at least $32.7 billion in taxpayer dollars every year. Reforms must bring about efficiency, transparency, and results. Failure to act now will jeopardize our nation’s long-term fiscal security.
Include Ideas from Governors and States
Rather than one-size-fits all Washington mandates, a comprehensive solution to health reform must include governors, state legislatures, and every American citizen.
Prioritizing Healthy Lifestyles and Preventing Disease
An ounce of prevention is worth a pound of cure. In practical terms, prevention is worth trillions of dollars saved in medical costs, increased productivity, improved quality of life, and added years of healthy living. Researchers have found that prevention activities can increase lifespans by at least 1.3 years.11
Yet, five preventable chronic diseases (heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes) cause two-thirds of American deaths while 75 percent of total health expenditures are spent to treat chronic diseases that are largely preventable.12 In government programs, the problem is even worse with chronic disease spending consuming 96 cents of every Medicare dollar and 82 cents of every Medicaid dollar.13 Just over $63 billion was allocated to all government prevention activities at the local, state, and federal levels, but the cost of care for preventable conditions is growing.14 Currently, more adults and children are developing diabetes and becoming overweight/obese, two conditions that can often be avoided with diet and physical activity.15 Epidemics, like HIV/AIDS, have been difficult to contain, and emerging public health threats, such as drug-resistant tuberculosis and hospital-acquired infections, pose new challenges.
Prevention requires efforts and investments today that are expected to provide long-term cost savings and other benefits. These outcomes are often difficult to measure, which hinder efforts to prioritize prevention and also allow ineffective programs to continue.
Innovative businesses have experienced significant returns on investment (ROI) from prevention programs—both in cost savings and worker productivity. The supermarket giant Safeway Inc. saved eleven percent on health care costs during the first year of a results-based prevention program.16 Johnson & Johnson’s integrative prevention program saved as much as $8.8 million in one year and reduced health risks related to high cholesterol levels, smoking, and high blood pressure.17 The fact is, we need to create a system and a society that focuses more on health, and less on care. The Patients’ Choice Act would complement private-sector prevention efforts by improving government prevention initiatives in a cost-effective and measurable manner. It does so specifically by: