Medical Tuesday Blog

A Better Choice by John Goodman, PhD

Oct 4

Written by: admin
10/04/2020 11:18 PM 

John Goodman, the father of Health Savings Accounts (HSAs), a Research Fellow at Mercatus and Senior Fellow at the Independent Institute, has brought together the pillars he has discussed in Priceless, but also further problems with the ACA of Obama, as well as some of his previous pieces published at the websites of Forbes and Psychology Today.

There may be none other who has written as extensively as Dr. Goodman. Nor analyzed the 2700-pagess Obama Care ACA bill which has produced 20,000 pages of regulations. Provisions are frequently changed and no one is quite sure about everything that’s in it. But Goodman thinks there are possibilities in “fixing” it. He lists four simple reforms that would solve many of the problems caused by the ACA. But then adds that much more needs to be done. Read more .  .  .

But why take something that perhaps no one has read the entire 2700 pages, or is sure of what it all means, and then start to repair? Isn’t the basic foundation also in need of repair? Would it not be better to take another look at what healthcare is all about? Most people are intimidate by what they see as the huge unknown that has been touted to jeopardize their financial security? They hear only of the huge bills from hospitals, surgeons, and emergency rooms. Aren’t these items easily definable? Then can they not be effectively categorized? Then these items can be effectively insured. Then why toss them in the huge melting pot of total health care?

Doing some research on the cost of routine outpatient health care, it is very difficult to come up with answers that matter. The costs are so tied up with insurance, that no insurance company was willing to give me the cost of single items without insurance.

Looking at the personal costs of annual exams, annual lab work, and routine medications. The chemistry panel that my doctor orders is listed by the insurance company as $360. On inquiry to the laboratory, the items paid in cash is only $90. My medications are listed at $1900 for the year. But I go to the discount houses which list 350 medications at $4 per month or $10 for three months’ supply.

Goodman works within the system. He lists six principles for common sense reform: Choice, Fairness, Universal Coverage, Portability, Patient Power, and Real Insurance. He suggests that to prevent dumping of the more costly patients, that if a more costly enrollee moves from plan A to plan B, then plan A should compensate plan B for the expected above average costs of the enrollee that changed plans. What would this alternative cost? Goodman states that if we take all of the employer-provided subsidies and add all of the subsidies the ACA is providing, there is more than enough money for the reforms he recommends.

Goodman recognizes that there is overuse when it’s free. But he does not think that the hypochondriacs are entirely the fault. He reminds us that all the insurance premiums are mixed and are in a pool. The money once it arrives in the pool is no longer ours. He lists all the costs of every item that we think are free which everyone can partake in, and the simple variation of everyone’s use of these items is rather variable. Then the increase costs of alcoholics or drug abusers will draw money from this pool faster than others.

In the tenth chapter, Goodman asks the question, “Can the ACA be Fixed?”

He states that it’s easier than you might suppose. He then states the four simple reforms that would solve many of the problems caused by the ACA:

  1. Replace all the ACA mandates and subsidies with a universal tax credit that is the same for everyone.
  2. Replace all the different types of medical savings accounts with a Roth Health Savings Account. (after-tax deposits and tax-free withdrawals)
  3. Allow Medicaid to compete with private insurance, with everyone having the right to buy in or get out.
  4. Denationalize and deregulate the exchanges and require them to institute change-of-health-status insurance.

He explains in the next two chapters how this all works out. I’m wondering how many of my patients would understand this. Would members of Congress understand this adequately enough to implement this health care program? Of course, we’ll have a new congress next month. But will they have greater cognition of the problem?

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John Goodman, the father of Health Savings Accounts (HSAs), a Research Fellow at Mercatus and Senior Fellow at the Independent Institute, has brought together the pillars he has discussed in Priceless, but also further problems with the ACA of Obama, as well as some of his previous pieces published at the websites of Forbes and Psychology Today.

There may be none other who has written as extensively as Dr. Goodman. Nor analyzed the 2700-pagess Obama Care ACA bill which has produced 20,000 pages of regulations. Provisions are frequently changed and no one is quite sure about everything that’s in it. But Goodman thinks there are possibilities in “fixing” it. He lists four simple reforms that would solve many of the problems caused by the ACA. But then adds that much more needs to be done. Read more .  .  .

But why take something that perhaps no one has read the entire 2700 pages, or is sure of what it all means, and then start to repair? Isn’t the basic foundation also in need of repair? Would it not be better to take another look at what healthcare is all about? Most people are intimidate by what they see as the huge unknown that has been touted to jeopardize their financial security? They hear only of the huge bills from hospitals, surgeons, and emergency rooms. Aren’t these items easily definable? Then can they not be effectively categorized? Then these items can be effectively insured. Then why toss them in the huge melting pot of total health care?

Doing some research on the cost of routine outpatient health care, it is very difficult to come up with answers that matter. The costs are so tied up with insurance, that no insurance company was willing to give me the cost of single items without insurance.

Looking at the personal costs of annual exams, annual lab work, and routine medications. The chemistry panel that my doctor orders is listed by the insurance company as $360. On inquiry to the laboratory, the items paid in cash is only $90. My medications are listed at $1900 for the year. But I go to the discount houses which list 350 medications at $4 per month or $10 for three months’ supply.

Goodman works within the system. He lists six principles for common sense reform: Choice, Fairness, Universal Coverage, Portability, Patient Power, and Real Insurance. He suggests that to prevent dumping of the more costly patients, that if a more costly enrollee moves from plan A to plan B, then plan A should compensate plan B for the expected above average costs of the enrollee that changed plans. What would this alternative cost? Goodman states that if we take all of the employer-provided subsidies and add all of the subsidies the ACA is providing, there is more than enough money for the reforms he recommends.

Goodman recognizes that there is overuse when it’s free. But he does not think that the hypochondriacs are entirely the fault. He reminds us that all the insurance premiums are mixed and are in a pool. The money once it arrives in the pool is no longer ours. He lists all the costs of every item that we think are free which everyone can partake in, and the simple variation of everyone’s use of these items is rather variable. Then the increase costs of alcoholics or drug abusers will draw money from this pool faster than others.

In the tenth chapter, Goodman asks the question, “Can the ACA be Fixed?”

He states that it’s easier than you might suppose. He then states the four simple reforms that would solve many of the problems caused by the ACA:

  1. Replace all the ACA mandates and subsidies with a universal tax credit that is the same for everyone.
  2. Replace all the different types of medical savings accounts with a Roth Health Savings Account. (after-tax deposits and tax-free withdrawals)
  3. Allow Medicaid to compete with private insurance, with everyone having the right to buy in or get out.
  4. Denationalize and deregulate the exchanges and require them to institute change-of-health-status insurance.

He explains in the next two chapters how this all works out. I’m wondering how many of my patients would understand this. Would members of Congress understand this adequately enough to implement this health care program? Of course, we’ll have a new congress next month. But will they have greater cognition of the problem?

Read more . . .
To read more book reviews . . .  
To read book reviews topically . . .  
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

The Book Review Section Is an Insider’s View of Medical Writing.

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