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    Where will the healthcare debate lead us?


    The assassination of President John F. Kennedy and the Democratic landslide in 1964 allowed for the passage of Medicare/Medicaid as an amendment to the Social Security law.  As a third-party payment system, it has a burgeoning bureaucracy, uncontrollable costs, interference in the patient-physician relationship with overwhelming physician reporting requirements, excessive lobbying by special interests, changing demographics causing financial strains and politicians at the center of healthcare. Multiple attempts to control costs have been unsuccessful.


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    The American Medical Association (AMA), during this decades-long healthcare debate, was rigid and unhelpful, resolving in 1920 against any form of government-funded care. They were concerned that a government-funded benefit would greatly impair the patient-physician relationship. They adamantly lobbied against the passage of Medicare/Medicaid in 1965, despite the need to care for the elderly and poor. The problem was that no compromise solution was offered to meet this need. This could have been done with means-tested vouchers to pay for routine care along with catastrophic coverage. Since the passage of Medicare/Medicaid, the AMA seems more interested in being a lobbying presence in Congress rather than a defender of its once sacrosanct patient-physician relationship.

    Despite this vitriolic debate between those who defend a government-dominated, mandatory system and others wanting more individuality with means-tested support, the people of our nation have been providing the solution. The growth of health savings accounts (HSAs) created in 2003, taking advantage of the tax laws and directing one’s own care, has been robust. The number of participants grew to 4.5 million in 2007 to 21 million Americans in 2017, with total assets of $42.7 billion. Another grass roots phenomenon has been the development of direct contracts with physicians providing comprehensive care, laboratory tests and drugs at far less cost.  With direct care physician overhead decreases significantly. At this time, about half of our states have passed laws stating that direct care contracts are NOT insurance. If considered insurance it would destroy the model because of the need for large reserve funds.   

    Presently, there already exists adequate government spending to provide means tested federal and state deposits for ALL Americans who wish to participate in tax advantaged HSAs. These accounts should by Congressional action also be able to pay for nationally available catastrophic insurance, routine care and direct physician contracts.  Those who wish otherwise could stay in the present system.


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    This would be an American solution to a difficult issue. Let individuals decide the style of healthcare that best meets their needs.


    Giving all Americans the choice of a payment or a benefit in healthcare would be a uniquely American solution with its emphasis on individuality.  

    Ken Fisher, MD
    Kenneth A. Fisher, M.D. Nephrologist, and author, latest book, Understanding Healthcare: A Historical Perspective", available ...


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      I want to choose what health care i get to have and get cheap insurance if i want. I want to drive a cheaper car that I get to choose the extras, and get a cheaper car without brakes! or seatbelts! i want to ride my motorcycle without a helmet! I dont want to pay for children to have a good education. I dont want to live in a society that keeps people healthy. let them die on the street. pay for body collectors instead.

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