Doctor presents options to improve medical coverage, lower costs

Recent letters to the editor have promoted universal medicare coverage for all. The last major change had promised that you could keep your doctor, and it would provide dramatic reduction of the cost of medical care. This did not work on either issue.

My proposal will allow choice, reduce overall cost by one-third of current levels, cover everyone, and reduce medical bankruptcy. First the VA system and Medicare would remain the same and Medicare would cover Medicaid.

A new idea that medical providers and clinics would be able to “write off” bad debt based on Medicare rates up to a percentage of charged revenues, say 10 percent. This would include foreign visitors (75 million) per year, indigents, and people between insurance coverage. All are covered and all have a choice. Currently physicians cannot “deduct” bad debt. Pro bono means free care, but someone still pays – usually doctors and clinics.

Another proposal would be that catastrophic loss cases would be covered by federal care similar to federal flood insurance, but with no premiums paid. That number might be anything over $1 million per case or event. Insurance companies would then have a cap on losses, and competition would be more vibrant with reduced premiums or deductibles.

Malpractice reform would be like Texas, with emphasis to reduce nuisance suits and promote mediation. Adoption of the British system of law, with “he who loses, pays” would reduce litigation costs.

Interstate insurance companies would have to be self-insured or bonded at large levels to prevent “fly-by-night" companies and fraud.

Health savings accounts would be for all, with savings transferred to retirement plans of the patient.

One medical health record and business system should be established to promote transparency and provide costs of common medical procedures or surgery. Patients would then have a choice on how much to pay out of pocket, and choose policies by price, deductibles, and potential of use.

The government wins as currently it costs a $1 trillion per year for Medicare and Medicaid. Insurance wins as catastrophic cases are covered by the government. Medical providers and clinics gain a deduction to help with cost margins. Medicare and VA continue in their current fashion. Patients can choose on every level the amounts of coverage or type and still have catastrophic coverage. If healthy, their medical savings would remain a retirement plan. Medical information and medical procedure costs would be transparent.

In my opinion, these changes would reduce costs by at least a third and patients still have their doctor, plan, and everyone, including visitors, are covered. Everyone has to give up something and everyone gains something.

If Congress cannot act on any of the above or the group as a whole, then the states themselves could implement each of the proposed changes individually and provide a “trial period.” The federal government cannot afford universal or one-payer health system as the cost would equal the total current federal budget. This would result in no defense budget, no Medicare and no Social Security.

Ways to improve our medical system with understandable options, reduced costs, and without destroying our excellent medical system are proposed. This would not occur with Medicare for All.

Michael A. Cassaday, DO,

Colonel, U.S. Army MC (retired)

Gastroenterologist (retired)