- Set payment rates for physicians at 130% of current Medicare, about where we were 30 years ago, considering inflation. Tie the reimbursement rate to the cost of living index, same as social security. If you cut physician pay 11%-40%, you will see mass retirement and the elimination of the most efficient care, office-based practice.
- Remove the practice expense payment from government-reported physician income since this is overhead spent to provide the care.
- Let all physicians participate, and don’t pay site-of-service differentials.
- Enact national tort reform, which would decrease the paperwork, overhead, and much useless defensive medicine.
- Press the generic drug manufacturers (but not the innovators) regarding drug costs. Bite the bullet, and set national coverage standards (ration care) to be revisited every 5 years, which will eliminate step therapy and prior authorizations. Allow individuals to pay out of pocket for additional treatments they want, including that questionable additional 90 days of life they may get from the $250,000 drug for the off-label indication.
- Press the hospitals, and don’t complain when many of them close, especially rural ones.
- Allow individuals, hospitals, and physicians to contract outside of the government plan (in contrast to Canada).
- Downsize the health insurance companies, and have them sell private supplemental insurance to whomever wants it.
Finally, make all of this a constitutional amendment. If not put out of reach, in 15 years we will have the same system we have today. The politicians simply will not be able to resist degrading (reforming, improving, refunding, defunding) the original plan. Or, you could simply increase Medicaid rates to Medicare rates and call it a day.
Oh, by the way, I saw that man from the New Year’s Eve party at the airport the following Christmas. He survived to get his government bypass and is doing well.
The health care system we have is miserable, except compared with all the others.
Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at dermnews@mdedge.com.