Recommendations for the Replacement of Obamacare

Thirty-five years of experience in the field as an international  clinician, researcher, academic and lecturer:

  1. Understand that healthcare delivery is not just limited to the general health insurance, there is also the workers compensation system, the No Fault (MVA), the slip and fall, Medicare SSDI and Medicaid. All of these subsystems deliver healthcare so if a patient is squeezed out of one system, s/he will seek the care in one of the others, even if s/he has to make up etiology and causality, e.g. every lung cancer will be asbestos-related because that is where the money is; every car accident will end up on Medicare/SSDI if s/he did not work for 12 month (exaggerating disability on purpose).
  2. Divorcing the legal profession from the medical will make healthcare in workers’ compensation and personal injury much cheaper, since lawyers would not be pushing unnecessary procedures, and since those will ultimately lead those patients to claiming SSDI, the latter costs (Medicare) will keep increasing.
  3. Tort reform, i.e. penalizing frivolous suits and paying both defense and plaintiff lawyers hourly and not on contingency, as well as capping damages, will limit the abuse of costly defensive tests.
  4. Make ONLY catastrophic insurance mandatory, meaning covering surgeries and hospital stays only; no consultation, outpatient care or medications. Premiums would be a lot cheaper. Patients could buy the whole coverage if they wish but that will be optional. If patients must buy their own meds for example, drugs will be a lot cheaper. Even today pharma has coupons for those who do not have insurance. Thus, ironically having insurance does make the drugs more expensive!
  5. Just like good drivers and good home owners, “good” patients should be rewarded if they stay healthy and watch what they do, drink, eat or smoke. They should have abatement of their premiums if they follow certain regimens or parameters. Also, unburden doctors and reward their good outcomes.
  6. Enable selling insurance across state line and country line. Many countries provide good care at much cheaper prices. Also, let the South Americans and Canadians buy into our insurance pools for instance.
  7. Encourage cooperatives and concierge medicine, as well as group bargaining, because they reign on costs and practice preventive medicine.
  8. Encourage all forms of Alternative Medicine because they are cheap and often do the job. Insurance should have plans including this. Also, foster and encourage the heal thyself trend.
  9. Just like auto or life insurance, those with pre-existing conditions should not be denied but their premiums can be higher for the mandatory catastrophic part within limits.
  10. All healthcare-related expenses should qualify for tax-free health savings accounts that can be pooled together for members of the same family and rolled over year after year.
  11. SSDI must be temporary unless the patient is above 65. SSI (Medicaid) must have work requirements.
  12. Avoid government subsidies as a rule, especially if they are based on the patient’s tax returns. Often these citizens have cash businesses and never pay taxes. It is always a recipe for fraud and abuse, as many examples prove it.
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