The Fundamental Necessity to Institute Quality Healthcare for Everyone

From Buzzwords to Realism

Originally published by Data Driven Investor on Medium

Photo by Raphael Schaller on Unsplash

Direct primary care, Medicare-for-all, affordable care act (ACA), and universal healthcare are a few of the thousand buzzwords floating around within the current healthcare planetary. In fact, for the majority of cases, the resentment and hostility associated with their enthusiasts are much stronger to point of beyond proportion than what they may individually represent.


Therefore, my intent is to shed an open-minded light on the dark side of today’s medical culture. The ultimate pragmatism may only be through making healthcare coverage for all in the short run and quality medical care for every individual in the distant future.

For those who have reached this far in my narrative, I must highlight, if you are convinced that the only way, we can ensure quality healthcare for all is by the way of government intervention or at the other extreme, boycotting the insurance industry and government-run programs is the ultimate solution, probably reading the rest of this chronicle will fail to convince you of the alternative options. Rest assured, there is no one silver bullet for the new world healthcare crisis we are living through, but certainly sundry of realistic and Practical approaches exist to build a practical tool and implement the necessary strategies to simulate one.

We must Entertain Options

The option is the most imperative attribute of any deed in the human’s life, more so in healthcare.

“I may be running out of options, but running out isn’t an option,” said Mark Lawrence, at Prince of Thorns

The option is an opportunity, as the opportunity is the facilitator of competitiveness, and quality of care. Former is the missing piece of the majority proposed solutions.

Let’s Examine some of the major Resolutions


The Patient Protection and Affordable Care Act (PPACA), often shortened to the Affordable Care Act (ACA) or dub Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Along with the Health Care and Education Reconciliation Act of 2010 amendments, it signifies the U.S. healthcare system’s most momentous regulatory renovation and expansion of coverage since the passage of Medicare and Medicaid in 1965. The individual mandate to purchase coverage is the fundamental component of the ACA, which Short of, ACA is rendered obsolete. Furthermore, to extend coverage to individuals who do not qualify through the state Medicaid expansion program the federal government has put in place subsidies to reimburse private third party insurance premiums to outspread coverage to the eligible population based on their proof of income with costs according to the Congressional Budget Office estimates that this funding would have cost about $130 billion from 2017 through 2026.

Direct Primary Care

In recent years a new system of cash for service has come up in the country, gaining significant popularity mostly among the physicians practicing in the Midwestern and southern states. Its basic business model is primarily based on the concept of the free market, known as Direct Primary Care (DPC). The model has revolutionized healthcare by allowing patients to directly pay the physicians for their care. Insurance companies are eliminated from the billing process under DPC, and in no way are able to influence the care patient desires. The term DPC encompasses different healthcare delivery systems that are based on financial relationships between the patient and the doctor. Direct Primary Care is about more than reimbursement. It signifies the fact that physicians are starting to step out of the woods and are educating their patients to do the same, which makes it the most important and valuable move of the past few decades.

Medicare for All

The original United States National Health Care Act or the Expanded and Improved Medicare for All Act is a bill introduced in the United States House of Representatives by former Representative John Conyers (D-MI) in 2003, with 25 Cosponsors. As of October 1, 2017, it had 120 Cosponsors, a majority of the Democratic caucus in the House of Representatives, and the highest level of support the bill has received since Conyers began annually introducing the bill in 2003. The act would establish a universal single-payer health care system in the United States, the jagged equivalent of Canada’s Medicare and Taiwan’s Bureau of National Health Insurance. Under a single-payer system, most medical care would be paid for by the federal government, ending the need for personal health insurance and premiums, and altering specific insurance companies as providing virtuously supplementary coverage, to be used when non-essential care is required. The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through the provision of preventative universal healthcare, and the elimination of the insurance company overhead and hospital billing costs. Medicare Parts A, B, C, and D. are the four distinct types of amended coverages available to eligible individuals under the Medicare proper. Each Medicare Part covers different healthcare-related costs. While Medicare Part A and Medicare Part B are administered by the Centers for Medicare and Medicaid Services (CMS), Medicare Part C, and Medicare Part D is managed by private insurance companies.

Medicaid Expansion

Medicaid expansion is a provision in the ACA called for expansion of Medicaid eligibility in order to cover more low-income Americans. Under the expansion, Medicaid eligibility would be extended to individuals with incomes up to 138 percent of the federal poverty level.

Healthcare Freedom Act

Recently Congressman Chip Roy (R-TX-21) introduces the Healthcare Freedom Act. It seems to be the reformed version of the already existing policy, Health Savings Account, or HSA, which is a tax-advantaged account that enables the patients to use to pay for current or future healthcare expenses. When combined with a high-deductible health plan, it is meant to offer savings and tax advantages that a traditional health plan can’t duplicate. The congressman’s proposed plan establishes what he calls “healthcare freedom accounts” (HFAs) which presumably acts as “health savings accounts” but with more flexibility to focus on immediate patient-physician relationship within the direct primary care (DPC) settings, provide portable catastrophic coverage, and give control back to the individual. He projects that HFA will reduce costs. The bill would prevent money deposited, by employer or individual, from being taxed. Up to $12,000 per year can be deposited into the account. That limit is extended to $17,000 for anyone over the age of 55.

The Drawbacks of the Current Solutions

The majority of solutions today have been subjected to the spectrum of challenges and their associate’s an example, the constitutionality of any component of the ACA is currently being challenged in the federal court. Besides constitutionality, one of the major flaws of the ACA is its radical extension of public funds through the federally subsidized program to the private corporations with very little accountability and transparency in place, rendering it the wastebasket for the taxpayer’s money.

Many stakeholders in the healthcare industry have promoted DPC for the benefits it brings, as it helps patients save expenses on primary care and other ancillary services such as clinical tests. The system also allows patients to be able to spend more time with their doctors and choose whom to receive care from. DPC is a great tool, but it also brings unique challenges to independent physicians. Because of its peculiar business model the DPC is vulnerable to be taken over by corporate companies through the “Uber scheme” making the already corporatized system shoddier. The lucrative nature of DPC is very appealing within the current corporate-dominated market, and a great opportunity to gain control over the medical practice. Direct primary care overhaul by the corporations would ignite a new flame within the already existingbrush fires doctors facing from the managed care systems and insurance companies.

In addition, in spite of the insurance industry's takeover of the healthcare arcade- by no means, it would be feasible to pull a blind eye over the main-stream 3rd party payer alternatives by abruptly switching over to the DPC or concierge medicine. DPC is the preliminary step towards physician empowerment and true patient-centered medical care, so it is on the path to serve as a fundamental reform initiative, in a sense that we can appreciate from the recent HFA bill proposed by congressman Chip Roy.

Medicare for all, on the other hand, is complex. Historically Medicare has been less than perfect, despite representing to be the better of the two evils amid private and government-run programs. Still, to include prescription drug coverage patients are forced to utilize supplementary government-sponsored subsidized programs. The Medicare Part C and D are administered through private insurance companies to address drug coverage, Hence, another wastebasket for the federally allocated funds.

Medicaid extension is the federally subsidized state-run program with limited Application. It primarily functions as a supplemental assurance to low-asset candidates, including children, pregnant women, parents of eligible children, people with disabilities, and elderly needing nursing home care. Naturally, such expansion has a limited scope and much shorter benefit terms.

The Significance of Realistic Attitude

Pessimism, Realism, Optimism is the mixture of the attitudes around the healthcare system. Patients are frustrated, physicians burned out; politicians are over-optimistic and pessimism is the evolving attitude. Nevertheless, realistic aptitude is a rare attribute in the midst of the ongoing crisis. Realism is a required optimum but requires transparency and knowledge, the latter of which is hardly attainable beyond proper transparency.

So, what is Realistically best Healthcare System?

A sensible system of healthcare would ultimately address every individual’s medical needs hinge on the available resources and economic status of the patient’s home community. A realistic option may not necessarily be within the direct and immediate reach practicality, thus may require supplementary steps, which may fail to seem ideal at the beginning, nonetheless be the only realistic alternative to help attain the ultimate goal. Perhaps, Medicare with all the flaws integrated within and the degree of dependence it has created among the eligible would be close to impossible to be gotten rid of without implementing a fallback system, even though, the contingency option may not be better than the original solution. It also deserves to be signified — — as the majority of politicians have a tendency to fail seeing beyond the substitute juncture, hence bushwhacking the alternative solutions by the virtue of its immediate denouement.

The utmost grail is to establish and maintain a free and transparent healthcare marketplace where each person can afford a personalized high-quality medical service. The optimum healthcare solution pertains to the best choice to start with addressing the immediate goal.

The swiftest objective is to make sure all Medicare beneficiaries maintain their coverage without the prerequisite to subsidizing private corporations. Whilst slow, but the transition can be smooth with a lesser bulk of regulations. Medicare is vast, bureaucratic, and inflexible; it requires ingrained structural reform. Its deficiencies undercut patients’ comprehensive and integrated care while increasing costs and generating debt. It eventually will require dissolution as the basic solution.

Medicare’s insufficient benefit package would lead to an enormous gap in coverage, requiring patients to buy costly supplemental insurances. One major defect is the inadequate solution for prescription-drug coverage as well as the complex framework.

Expanding Medicaid is not an ideal long-term solution if quality healthcare for all is anticipated; nevertheless, it serves as a legitimate stepping stone to a fundamentally operational solution that is flexible and affordable. However, the expanded Medicaid to all will require federal support through the allocation of already established Medicare funds, through a transparent structured accountable gated stream.

Municipality of negotiation between the public and private entities

Direct negotiation between private and government entities must be avoided unless it is short-lived or absolutely necessary, but in order to avoid unnecessary pitfalls throughout the transition, such negotiations must be practiced at the smaller community segments as permissible. For instance, Negotiating drug formulary and price by the county administration with the help of domain experts is the most ideal, as the socioeconomic and community standards of medical practice varies between municipals, thus logical to entertain the negotiation of drugs independently. The same would apply to conciliation for laboratory and radiology services within the discretion of the county governance. Due to the potential economic variation from one borough to another as well as the variability of the standard of care for the same reason, it is prudent to respect the autonomy of individual target populations. But unfortunately in contrast to the decentralization of negotiation historically it has been advantageous for the corporations to maintain the negotiations as centrally as possible at the state or national scale. Since every clinic, physician and provider offer a different set of quality of care, and every community holds a contrasting healthcare market, physician fees schedule also ideally determined independently by every metropolitan district.

The Concept of bidding in the Expanded Medicare system

The bidding system has applied in many aspects of government projects and negotiations with private entities. It creates competition, improves quality, and reduces costs. It would also be practical for every county to adapt bidding practice while negotiating for drugs, medical supplies, and services with the private businesses.

Based on the concept of providing options, no-obligation, individual districts must have the option to opt-out of the Medicaid system in reflection to their internal referendum, economic status, and market standing, while maintaining access to the transparent negotiated pricing from other counties. To avoid neglectful Opt-out, it must be entertained contingent on purchasing private insurance or available cash assets in the account dedicated to health. Latter must also respect the individual choice without jeopardizing the right of fellow citizens. To prevent kickback practices and monopoly, the recourse to import prescription drugs under a well-structured quality assurance program should be available to everyone, as It will respect the fundamentals of the free market.

The county and state legislators must make necessary efforts to widen the Spectrum of options by promoting across the state line insurance coverage purchase which will increase competition and reduce costs.

Incorporating social and individual determinants of health and wellness by each county and creating benchmark studies between counties and clinics make the outcome transparent to the public, gradually prompt a competitive environment, and establishes free open sooq. Patients should be empowered by positioning them in control of their own medical record, support Physicians by forming an alliance of independent physician’s collaborator in the county and incentivizing them to contribute. Engage every stakeholder throughout the process without the bias of financial incentives.

The ultimate goal is equalizing the value of care and cost between the cash, Medicaid, and private insurance and a Healthcare for all through eliminating the socioeconomic and geographic barriers.

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