A System for Health Care by Dr. Paul Nussbaum

The United States is engaged again in a debate on health care and the best system to provide and receive health care. Other nations across the planet have similar debates and there are different approaches to care in different countries. I add my opinions as a provider and consumer of health care to have some more fun muddying the waters.

First, it is my opinion that health care, like housing, clothing, and transportation is not a right, but a privilege. I will continue to scour the US Constitution for the right on health care, but to date I have not found it. With housing, clothing, and transportation citizens choose to purchase products based on ability to afford. There is no single car, house, or pair of pants that folks use; we are diverse based on our ability to afford. Health care really is no different.

As a provider the most frustrating thing is that I need to get permission from a complete stranger to examine and treat a patient, I am told how much I can charge, and I am further told how much I will get paid. I wonder if anyone reading this will consider what it would be like to have to call someone to sell a pair shoes, sell a car, or to purchase a house. I wonder what it would be like for you to be told you are only permitted to sell this shoe or that house and that your commission on that sale will only be a certain percent!

It seems to me that most consumers are pretty smart and understand what they can and cannot afford. If I place my name and title on an office building the consumer may choose to solicit and pay for my services. My fees will not be unreasonable because the consumer will go to the next doctor who charges less and I will be out of business. I will be able to work directly with the consumer who will exchange a fee for my professional service.

As a consumer, I have recently purchased a Health Savings Account (HSA) as I am self-employed. I find the ability to manage my own health account valuable and freeing. I enjoy asking the nurse or doctor how much a procedure costs and then choosing a less expensive procedure or I simply do not have the procedure. With an HSA I am able to approach utilization and purchase of health care services the way I approach other products and services in the market. I am in control.

One final opinion is that the United States is far too medicalized, too invasive, too bureaucratic, and too expensive. We have some great professionals and tremendous resources, but we neglect the simple things that can really curb disease and chronic conditions. We do not focus on exercise, nutrition, stress reduction, cognitive stimulation, and communication. We do not do enough to curb bad habits and we view all of these things as external to the “real health care system” when these are the precise behaviors that cause the medical conditions that are so expensive.

Some suggestions for health care delivery might include the following:

1. Put the consumer in charge of his or her health care and treat it no different than other products in the market
2. Create a standard basic safety net for major medical crises that will probably need to be both employer and government subsidized and that means taxpayers.
3. Get rid of all middle layers of the health care bureaucracy. There should not be anyone employed for precertification, preauthorization, or claims management. The doctor and the consumer will manage this as the consumer does with other products purchased everyday.
4. Each doctor will set his or her pricing and the consumer will decide if the prices are reasonable.
5. Stop dictating to doctors what procedures can and cannot be performed. They are licensed in medicine to already know what to do and do not need a bureaucrat to tell them this information.
6. Create products that are preventative and wellness based across the lifespan that the consumer can purchase. These products or programs should be part of the primary health care system.

Dr.Paul Nussbaum

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