by Wayne Oliver
Originally published in Real Clear Politics on October 14, 2016
Last week, Bill Clinton called the Affordable Care Act, “the craziest thing in the world” as it is creating expensive, unaffordable health care for those who earn too much to be on Medicaid, small business and individuals who earn too much to obtain government subsidies. He later walked back his criticism saying the ACA helped insure many who were uninsured.
Residents of Arizona, Tennessee and Georgia and a host of other states might agree. ACA health insurance premiums next year are set to rise as much as 68 percent in Arizona and 62 percent in Tennessee. In Georgia the average increase will be 33 percent.
Alabama will be down to one insurance carrier.
Healthcare is now the most expensive item in the family budget with ever-increasing deductibles, co-pays and out-of-pocket expenses for those with employer-sponsored health insurance. For example, the Kaiser Family Foundation just released its annual survey that found the average premium for family healthcare coverage through a job is now $18,142 annually with the employee paying $5,277 toward the cost.
The consensus is the ACA failed to reduce healthcare costs.
If we are to make healthcare affordable for everyone, the answer is not going to come from a President Hillary Clinton or a President Donald Trump. Instead, the solution can be found if we send healthcare back to the states where experimentation and innovative public policies can take place focusing on utilization and waste in healthcare.
It is there that we can look to states already on the move. Florida, Georgia, Tennessee and Alabama are considering a bold concept to reduce waste by reducing the need to practice of wasteful, defensive medicine.
Defensive medicine is any type of medical practice to avoid litigation such as tests, scans, medications and procedures. The vast majority of physicians are tacitly taught defensive medicine by mentors and professors to practice defensive medicine to protect themselves from litigation.
Gallup conducted a nationwide survey of physicians and found that 26 percent of healthcare costs could be attributed to defensive medicine. BioScience Valuation, a healthcare economics firm, said that doctors ordered $487 billion in such wasteful, defensive medicine in 2015.
To contain this out of control spending, we have to encourage physicians to stop practicing defensive medicine. The proposal before these four state Legislatures would do just that by abolishing each state’s medical malpractice system and replacing it with a no-blame administrative model.
Known as the Patients’ Compensation System or PCS, the pioneering concept is drawing attention in the medical community as it would change the behavior of those of the front lines of medicine.
Under the PCS model, a patient who was medically injured would file a claim with a panel of healthcare experts instead of filing a lawsuit. The panel of experts and an administrative law judge would determine if a medical injury occurred and if so the patient would be eligible for compensation based on a schedule similar to the payouts traditionally offered in a legal system. The doctor would not be personally held liable.
The patient would be compensated in a timely manner. Compensation would come from funds generated from physicians’ administrative fees. Only trial lawyers would lose out as they would not be able to generate enormous fees that come with years of litigation.
There are physicians who have told us they have no hesitation in ordering a battery of tests for patients if it reduces the anxiety of a patient or family member and reduces the risk of any potential liability claim. As long as a physician could lose his or her entire net worth in a malpractice suit, each will continue the practice of defensive medicine.
A survey released last year by the Official Journal of the Congress of Neurological Surgeons found that more than 75 percent of neurosurgeons said they practice defensive medicine to protect themselves from lawsuits.
Meanwhile, a 2014 survey of hospital administrators conducted by Jackson Healthcare found that 32 percent of healthcare costs generated in a hospital setting could be attributed to such wasteful, defensive medicine.
Under the current state of healthcare, we are rearranging the deck chairs on the Titanic as the ACA and other efforts do nothing more than continue to make healthcare unaffordable and an unsustainable burden for all of us.
The definition of insanity is doing the same thing over and over again and expecting different results. Instead of looking to Congress or a new President for answers, let’s look to state lawmakers who have creative new ideas to eliminate waste, reduce costs and make patients whole more quickly.