Acton Commentary

Patients’ Choice Act -- A Better Prescription


In late May, Senators Tom Coburn and Richard Burr, and Representatives Paul Ryan and Devin Nunes, all Republicans, offered a new prescription for health care reform that is a vast improvement over what we’ve seen previously from Washington. The “Patients’ Choice Act” (PCA), as its sponsors refer to the proposal, honestly confronts the unsustainable and unjust realities of our current medical system.

Despite good intentions, many reform proposals increase the role of government, place additional burdens on business, and interfere with medical decision making between the patient and doctor. Yet, without substantial health care reform, the United States will suffer from a greater financial disaster than is anticipated in the current crisis, and will unconscionably burden our children and grandchildren with debt and inflation. The PCA represents a more promising approach.

Our government is already responsible for 50 percent of health care spending. It has failed to control spending and promote quality. The Medicare trust fund will be insolvent by 2017 (Part A or hospital insurance). The combination of aging baby boomers and increasingly expensive treatments has led to medical spending exceeding the growth in our Gross Domestic Product year after year. This cannot continue. Yet many reform proposals advocate expanding Medicare, Medicaid, or new public health care programs, when our government is already fiscally failing to handle half of America’s health care.

As those of us who live in Michigan know all too well, job-providing businesses are having trouble competing in global markets when competitors are not handicapped with similar benefit package requirements. Where will jobs come from if employers have to bear greater responsibility for health care expenses, as many reform proposals suggest? Furthermore, we have also learned we would rather have health insurance obtained outside the workplace, so that when businesses close or move, or we become unable to work, our health insurance is not jeopardized. Anyone who has lost a job and learned how much COBRA insurance costs—without a paycheck—understands the value of affordable and portable health insurance.

Furthermore, many reform proposals interfere with the doctor-patient relationship. The heavy hand of government is already leading to shortages of physicians, particularly in primary care specialties. Michigan is likely to be short-handed by 6,000 physicians by 2020. Three-quarters of health care spending and two-thirds of deaths are due to chronic conditions such as diabetic, heart, and lung disease. Preventive medicine and patient responsibility for personal decisions affecting health care can make a tremendous difference in health and health care spending. Rules, regulations, and bureaucracy contribute to patients’ losing both their greatest ally in understanding complex medical issues and their best advocate in promoting a healthy lifestyle.

The PCA will enhance patient and family ability to afford health care insurance and incentivize healthier lifestyles. As the name suggests, patients will have freedom of choice for health care insurance. This proposal would more justly allocate the current $300 billion tax subsidy for employer provided health care. In addition, it would surpass other options in fulfilling our social responsibility to the poor and vulnerable.

Sixty percent of working Americans obtain health care insurance through their employer. Both employee and employer benefit from a significant tax break, whether they realize it or not. Wages are lower when employees receive health care benefits, whether they realize it or not, too.

The 40 percent of workers who pay out of pocket understand that they pay dearly for health insurance. These individuals may resent that they are paying taxes to subsidize those receiving the $300 billion federal tax subsidy for employer based health care, particularly when those making more money get a bigger tax break.

People who take care of themselves with healthy diet, regular exercise, and avoidance of harmful habits are probably over-insured. Most workers would be better off if they received the tax break themselves, received a bigger paycheck, and could purchase lower cost insurance directly. This would certainly be fairer for those paying taxes but missing out on the tax break.

The PCA replaces the unfair ‘at work’ tax subsidy to give people an ‘at home’ tax break for health care expenses. For those who need help affording insurance there will be assistance in the form of refundable tax credits for individuals and families. State insurance exchanges are proposed to increase competitive pressures on insurance companies, which often possess monopolistic power, and ensure people with chronic illness receive help.

The PCA is not only fiscally responsible, it also fulfills our social responsibilities.

Human dignity is respected when we fulfill our duty to improve access to health care through reforms that increase affordability and quality of care. Personal responsibility is promoted by enabling patients and families to assume greater responsibility for their health care. Immigrants and Native Americans’ needs are considered in this plan. Veterans who sometimes may be better served outside the Veteran’s Health Administration are provided this opportunity.

Market-oriented changes to improve the allocation of $2.4 trillion in annual health care spending can advance the common good more effectively than can increased third party decision making. Mandates, often prompted by special interest lobbying efforts rather than patient demand, have increased the cost of insurance beyond affordability for many citizens. More mandates mean more expensive health insurance, and fewer people able to buy it.

The poor and vulnerable would benefit more from subsidized access to the health care market-place than from expanding government health care authority. Medicaid reimbursement for doctors and hospitals does not cover the cost of providing care. As a result, patients on Medicaid have difficulty with access to providers and rely on costly emergency rooms for care. The safety net for those with chronic disease can be maintained at the state level by insurers of last resort.

Facilitating health care by those closest to those in need, rather than government or employer, begins with the family and doctor-patient relationship. Churches, community organizations, and employee associations should be helped to care for their members rather than higher, and less personal, levels of society.

But, as the language of the PCA warns, expanding the reach of government would create a health care system displaying “the compassion of the IRS, the efficiency of the post office, and the incompetence of Katrina.” The proposed PCA bill will instead empower patients, with the helping hand of their doctors. It prescribes reform with financial responsibility and without bankrupting our children and grandchildren. Finally, the PCA would fulfill our social responsibility to those in need while increasing the competitive ability of American business. This is the right prescription for health care reform.


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