Three more things to save free healthcare, briefly.

1. Tort reform. The lawyers are still sucking billions out of the sector. Add realty, not the legal lottery, to deal with legimate nonnegligent errors. Allow liability waivers for nonnegligence – it is a risky business and patients need to understand. Remove true negligence from attorneys to arbitrators with realistics, actual damage settlements.

2. Deregulate treatment. The AMA has a monopoly. Allow nurses, medics, ENT's, moms, grandmas, and anyone else practice medicine. Disclose their qualifications, allow liability waivers, protect from litigation, but hang the frauds. A prudent practitioner will refer real problems above their qualifications. If a former army medic can glue or stitch a basic wound closed and give care instructions, for a fraction of the typical costs – let them. They know artery, nerve etc. damage. For all of history until now, midwives delivered babies at home. Again, they know complications. All of this is great for indigents, noninsureds, illegals etc. I can't get the same annual physical for free that the president receives. Medical treatment is not a right or entitlement – it is a privilege.

3. Allow pharmacists to prescribe medicine. They know more about it then doctors. We have the infrastructure to control dangerous and additive substances. Again, allow liability waivers, protect from litigation, but hang frauds. Everyone knows the drug salesmen payola game.

* Medical schools need to teach med students to be health teachers. The model for them to follow would be Naturopathic physicians, who are trained to see themselves as health teachers. As a result, they have better relationships with their clients and healthier clients.
* Medical doctors should be rewarded when their patients stay healthy and penalized when they fall ill. When this is the case, MD’s will be motivated to teach health, rather than to draw profit from treating disease. Revolutionary concept to MD’s.

I have no problem telling a patient my costs and my results for medical and surgical practice. In fact I have no problem posting compliance with measures derived by my specialty society.

However, having been a member of the AQA and other bodies creating such measures, I can affirm that they are derived in processes that are influenced heavily by politics, they are watered down or inaccurate and often need to change. The cost measures are really based on “efficiency” and reflect how well physicians ration care in ways that are designed to meet arbitrary and invalid ranges set up to benefit third-party payers (episode treatment group – ETGs).

I applaud opposition to such faux-transparency. Real transparency will come when patients control the spending for their routine annual health care (backed by high deductible health plans).

I have attached a paper I wrote on the risks and unintended consequences of PFP (which applies to ill conceived public reporting) and presented last year at the AMA.

Last October, the California Medical Association passed a resolution I wrote, asking the legislature to allow physicians to directly contract with their patients and for that direct contract to supersede other contracts. The way this SHOULD work is thus: 1) patient contracts with their physician, 2) patient contracts with their insurer. Patient pays the physician. Physician is accountable to patient. Patient may be reimbursed by insurance. END.

As it is with PPO insurance and with Medicare (or any government insurance plan) this triangulation allows for the interference of the insurer or the government.

It is a zoo out there. Most of the cost of care is borne by those trying to navigate the system. If only all the animals would just get back in their cage and do their job. Insurers should be insurers, doctors should be doctors… etc, etc. It is more than triangulation … it is strangulation and it is killing us.

That said. We have solved this problem in Long Beach. Please see healthylongbeach.org. This is a website that we have initiated to speak to the problem of price transparency and access. Access is not about a card. It is about knowing that your doctor is at the other end of the phone and “what” is on the other end of the phone…. What am I buying? What is its value? Value is personal. Cost must be transparent and public. So, we asked all providers in Long Beach to post their retail prices… all doctors, hospitals, surgery centers, imaging centers, etc. This is all posted on one site. Patients can even find an HSA to purchase or insurance to purchase. That is access. And we have support from the mayor and the city council and all legislators. The county (public systems) also knows that there is nothing wrong and everything right about telling a patient about the cost of care. ER’s can and should have cash registers.

Why should a patient with or without insurance be saddled with crazy “billed charges” hanging over their head. I personally feel that this is OBSTRUCTIVE to care.

Finally, why shouldn’t every insurer be MANDATED (I cannot believe I used that word) to post their payment schedule. We pay $1500 to your hospital for an appendectomy regardless of what hospital the patient uses if the patient purchases our ABC plan. Now, the patient sees the hospital’s fee schedule, the insurer’s payment schedule and he or she knows precisely the cost to him or her. The end. Case closed.

And… if a hospital wants to compete and actually sell quality… it can sell Appendectomies for $2000 ($100 more than the hospital down the street) and “sell” better service because it will take you home after the procedure and feed you dinner… (or whatever)…

Point is … legitimate transparency stimulates quality and competition. It is a good thing … but it has to be properly defined and processed.