LCHM Fall 2017 - 27
L C M E D S O C .O R G
$5,000 per year in premiums. The ACA "lives
or dies" on this annual $85 billion of revenue.
The ACA has included multibillion dollar
subsidies for mandated pre-conditions and
elective healthcare. More than $70 billion
has been shifted from Medicare to subsidize
increased outlays for Medicaid and tax credits
for certain small employers. (10) In 2017 a
Medicare and Medicaid $1,200 billion deficit
will be added to the Federal deficit. Some people
judge U.S. healthcare as too expensive, wasteful
and not valuable. Compassionate physicians,
smart technology, and insurance companies
have the ability to cure this problem.
An Independent Payment Advisory Board
(IPAB) was appointed by the Executive Branch.
(11)(12) The IPAB can modify physician
payment and physicians who provide service
for less money receive bonuses. (13) This "pay
for satisfaction" may contribute to excessive
laboratory studies and hundreds of billions of
dollars of other "inefficiencies."
In 2016 duplication of drugs and services
and inefficiencies is estimated to be 26% of
Healthcare spending. (14) The Congressional
Budget Office states, "Federal health programs
are growing at an unsustainable rate currently
consuming 28 percent of the Federal budget."
(15) Experts report USA patients overuse
health services and physicians over-prescribe
healthcare. "Much waste is driven by the way
U.S. healthcare is organized, delivered and
paid for." (16)
The 2017 the House of Representative passed
the American Health Care Act (AHCA). The
CBO estimates the Act would reduce federal
deficits by an average $23 billion a year and
increase the people who are uninsured by an
average 23 million in 2028. (17) These savings
are budget dust in comparison to the waste
The 2010 ACA spreads the risk among all
working citizens and favors older and high risk
enrollees and patients with preconditions. The
proposed 2017 Senate Better Healthcare Act
rules that high-risk working enrollees should
pay an age adjusted higher premium. (18)
I favor USA healthcare
that is affordable.
To date, neither the failed 2017 AHCA, 2017
Senate Better Healthcare Bill and failed Skinny
Healthcare Bill identified the over $700 billion
a year of waste. The $700 billion in savings
per year would more than pay for the dollars
needed for high risk patients and patients with
preconditions and citizens in the lower income
quartiles on Medicaid. Physicians hold the "pen"
that spends healthcare dollars. New healthcare
must encourage physicians to eliminate waste
and provide best evidence-based care for less cost.
It is estimated that tort reform, a uniform
billing form, economies of scale, a uniform
and secure electronic medical record system, a
reduction in unnecessary drugs, use of generic
drugs and competition would save more than
$180 billion per year. The Dartmouth Institute
for Health and Clinical Practice and others
report that eliminating all waste and abuse
and changing how U.S. healthcare is managed
can save more than $700 billion a year. (19)
Physicians should be allowed to practice
medicine unimpeded by government. Physicians
should provide price transparency for patients.
choice and catastrophic and elective care
insured separately. State Medicaid and CHIP
expenses would be budget neutral as is required
by their constitutions.
States would cap Medicaid funds indexed to
inflation. States would make Medicaid subsidies
temporary for able bodied working age adults.
Physicians would reduce hospitalizations for
chronic diseases and transition frail and elderly to
community care from nursing homes. Hospital
networks and insurance companies would cut
unnecessary administration. Insurance would
be available and transferable across state lines
and from job to job.
I favor healthcare that would be valuable.
Value is defined as best evidence-based care and
best results divided by dollars spent to achieve
results. Healthcare would cover preconditions.
New healthcare would eliminate government
mandates for elective care. States' Department
of Justices would find and prosecute medical
fraud. Electronic medical systems would decrease cost by expanded patient self-monitoring
I favor USA healthcare that is affordable. It
would include competition and free market
Continued on page 28
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FALL 2017 | Lehigh County Health & Medicine 27
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