OP-ED: The Conservative Way Forward On Health Care
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The landslide Republican victory, in taking the House and electing some strong conservatives to the Senate, can be interpreted as a mandate to rein in government spending, and specifically to repeal ObamaCare, as these issues were clearly behind the large turnout.  There is still a very real possibility the Supreme Court will find the “individual mandate” to buy private insurance unconstitutional.  If this provision is thrown out, it’s hard to see how the law survives, since the mandate is needed to finance it. 

Now is an excellent time to construct a conservative alternative vision for true reform of our health care delivery system.  Since most current problems with the health care system stem from government, a conservative plan should seek to reduce its role. 

It goes without saying that the Patient Protection and Affordable Care Act must be repealed since, like all the laws passed by this administration, it does precisely the opposite of what its name suggests.   By massively increasing the health care bureaucracy at the expense of actual providers of care, it will make care harder to access and more expensive.   Many physicians will take early retirement and the already great physician shortage will be exacerbated.  

The law is too large and complex to waste time foraging for items to salvage.  There is a great risk of leaving behind hidden mandates and rules that will be harmful.  Better to scrap the whole thing.  With Democrat Senators running scared for their jobs in 2012, it is conceivable the Senate would also vote for repeal (Harry Reid notwithstanding).  But not even the most generous view of Barack Obama’s ideological flexibility has him signing a repeal bill, and a veto override is out of the question for now. 

It may be possible, however, to enact affirmative measures that make ObamaCare irrelevant.  Here are some common sense, free market proposals, many of which were proposed and discussed, but ignored by the President and the Congressional leadership in the run-up to passage of ObamaCare.

1. Transfer the tax deduction for health care spending from employers to individuals. This would end the absurdity of purchasing health insurance at the "company store," a practice that limits individual choice and liberty, nourishes a sense of dependency, and promotes overuse of care.  This policy, an accident of WW II wage and price controls, was the “original sin” in health care financing; doing away with it would empower consumers to shop for the best plan for their families, which will lower premiums.

2.  Remove barriers to the interstate sale of health insurance.   There is broad agreement on this proposition.  It would increase choice and competition between insurers and drive down premiums by effectively ending state mandates that drive them up. 

3. Deregulate and allow greater contributions to Health Savings Accounts.  These fabulous tax shelters give individuals more control over their health spending, and, coupled with an inexpensive policy to cover catastrophic illness (i.e., true insurance), are all most people need.  By returning most health care purchasing decisions to consumers, spending will immediately be slowed and prices curbed.   This is the conservative, free market, already tested and proven way to "bend the cost curve down." 

4. Follow the recommendations of the bipartisan Breaux Commission and give Medicare beneficiaries a means-tested stipend to buy private insurance.  This solution came during the Clinton era but was too free-market to pass muster with Bill and Hillary.  With Medicare moments from insolvency, there should again be a bipartisan consensus to reform this behemoth.

5. Transfer (gradually) all Medicaid responsibility to the states.  Federal support for Medicaid allows much greater spending than would otherwise occur.  It forces frugal states to subsidize lavish coverage in New York, California, and elsewhere.  States should have complete freedom to organize their Medicaid systems along their own priorities, in exchange for losing, over perhaps five years, the federal subsidy.  This would encourage states to find innovative ways of providing health insurance for the poor, such as individual health accounts, or subsidies to buy private insurance.

The latter two points would allow the mammoth Center for Medicare and Medicaid Services to be mothballed, though Medicare could retain a role as insurer of last resort for those with pre-existing, expensive, chronic diseases.

6. Institute a "loser pays" system for medical malpractice to cut frivolous lawsuits.  The ability to launch a lawsuit (and this applies beyond medical malpractice) with minimal financial risk is the reason behind the explosion of malpractice litigation, with all the associated costs.  Tort reform at the federal level would require the Senate to override the trial lawyers’ veto, which could be a problem.  This reform should be pushed at the state level.

7. Finally, for true patient protection, let's propose a constitutional amendment to guarantee the individual's right to privately contract for medical care.  This will eliminate for all time the threat to the private practice of medicine and assure that, no matter what system is in place, patients will always be allowed to spend their own money on care.

The above points are clear, simple and practical solutions. They empower the individual and greatly reduce malignant government influence and unburden the taxpayer.  It is the conservative way forward on health care.

Richard Amerling, MD is a nephrologist practicing in New York City.  He is an Associate Professor of clinical medicine at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center.  Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981.  He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania.  He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).

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Members Opinions:
November 22, 2010 at 11:39am
Nothing in this letter denotes anything but support for big business and assistance to insurance companies to keep on doing what they do. Deregulate?! We all see how well massive companies take the common man into consideration when it comes to having free reign to operate for profit rather than common sense.

Empower the individual?

This diatribe empowers the current broken ridiculous system if you ask me. This idea that business makes the world go around with no other options available lends itself to interpreting the future United States of America as just one big corporate state.

Saying that fixing the insurance companies, lobbyist, Wall Street , etc, on a national scale yet canvasing for local state control over Medicaid says, "We can't make money with this... Here, state; "X"... It's in your hands now!" but please continue to let us burden you with contradictory high health costs...
November 22, 2010 at 12:35pm
Love the op-ed, but Obama care doesn't do all he claims. The mandate isn't a mandate, in the law it's set up as a tax which you don't have to pay if you have health INS. The theory is that people without INS cost tax payers when they use the healthcare system but have no way to pay.
It is correct that people stay at jobs they don't like because of fear of not having INS.
The problem with allowing INS to be sold across state lines, is that the state with the least regulations and protections for the consumer would be where all the INS companies would base thier operations.
The argument about tort reform is that lawsuits is a very small percentage of healthcare costs. Also tort reform would make it to expensive to get compensation for damages caused by malpractice (imagine it was you or you family member whose life was destroyed by an incompetent doctor).
Are you suggesting we should allow INS companies to continue kicking consumers off whenever they find one small forgotten bit of information when they come down with a serious illness?
Don't worry, just like most of what Obama has done, it's 75 percent smoke screen, there is no enforcement mechanism in place to force people to pay the fee, or to force the INS companies to comply with the new laws.
November 22, 2010 at 1:35pm
Ditto with JEFF!
November 22, 2010 at 6:55pm
This is a voice for private physicians. I looked it up. They want you to sign a declaration.No way. Check this out. On the link below.
November 22, 2010 at 7:46pm
A clip and paste from Wikipedia:

"Positions
Though it describes itself as "non-partisan",AAPS is generally recognized as politically conservative. According to Mother Jones, "despite the lab coats and the official-sounding name, the docs of the AAPS are hardly part of mainstream medical society. Think Glenn Beck with an MD."

The organization opposes mandatory vaccination, universal health care and government intervention in healthcare. The AAPS has characterized the effects of the Social Security Act of 1965, which established Medicare and Medicaid, as "evil" and "immoral", and encouraged member physicians to boycott Medicare and Medicaid. AAPS argues that individuals should purchase medical care directly from doctors, and that there is no right to medical care. The organization requires its members to sign a "declaration of independence" pledging that they will not work with Medicare, Medicaid, or even private insurance companies.

AAPS also opposes mandated evidence-based medicine and practice guidelines, criticizing them as a usurpation of physician autonomy and a fascist merger of state and corporate power where the biggest stakeholder is the pharmaceutical industry. Other procedures that AAPS opposes include abortion and over-the-counter access to emergency contraception. AAPS also opposes electronic medical records as well as any "direct or de facto supervision or control over the practice of medicine by federal officers or employees."

On Oct 25 2008 the AAPS website published an editorial implying that Barack Obama was using Neuro-linguistic Programming, "a covert form of hypnosis", in his presidential campaign."



Back to the middle ages -- no more shots and getting rid of those twin evils and immoral creations of Medicare and Medicaid.

Flaky???? Nutty???? Or just plain crazy...
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November 23, 2010 at 4:19pm
dailyreader, I am disappointed. Even Glenn Beck, when railing against the various liberal organizations he loathes, states why, and challenges their propaganda with his own. All you did with your post is attack the messenger, without challenging the message.
November 23, 2010 at 6:29pm
Mr. Halpern. this needs challenging?

"effects of the Social Security Act of 1965, which established Medicare and Medicaid, as "evil" and "immoral",... "sign a "declaration of independence" pledging that they will not work with Medicare, Medicaid, or even private insurance companies".."opposes mandated evidence-based medicine and practice guidelines"..."opposes mandatory vaccination"
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November 23, 2010 at 6:43pm
No, the points of his column are what you would challenge, if you could.
November 24, 2010 at 8:38am
If you follow the link at the end of the op-ed, it brings you to an organization that suggests any third party (INS , Medicare, Medicaid) set up to pay a medical bill, will eventually ration healthcare to some degree. While this is obviously true, unless you are an extremely rich person, you can not have security concerning your health care without some type of health INS. 
   Health INS is the distribution of risk over large numbers of individuals. Some people won't use their share by staying healthy or dying early, and some will use much more than they pay in. Everyone receives the security and reduction in stress from having health INS, and will most likely live longer just from having the security. 
   Democratic party believes the government could perform the task of being the best insurer because polititions are elected and work for the people voting, which gives the people some say in how money is paid out and for what. They believe a private INS company is profit motivated and need to make large profits to pay share holders, and over paid CEO's, which causes them to look for ways to cut expensive healthcare when it's most needed.
   Republicans believe the government can't be trusted with anything and prefer to put their faith in the profit motivated corporation to be fair. 
   We will all need healthcare eventually. Democrats want to ensure we all have health INS, (the wealthy should pay more for this security and the poor should pay less). republicans believe, the quality of health INS should depend on your ability to pay (wealthy get excellent health care, poor people die early). 
   Anyone disagree with this? Please explain in detail if you do.
November 24, 2010 at 11:24am
That dork36 couldn't have been said better. Ditto.
November 24, 2010 at 1:03pm
There was a new house member by the name of Andy Harris gop out of Maryland that complianed during his orientation that his new health insurance that he was going to get had a 30 day waiting period.He was upset about that.The ins I am taking about is the fedreal health care that he was about to get from the federal goverment. The GOP cannot enroll in the same kind of coverage that they want for themselves and in turn deny that same coverage to the other Americans. That would make all of them hypocrites. They should all have to sign a pledge to not take the federal health insurance that they want to repeal.If they are going to tslk the tslk then they must walk the walk also.
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November 24, 2010 at 1:17pm
ObamaCare does not offer the average citizen federal health insurance. Those of us who are not federal employees (just taxpayers) are not being offered the same type of coverage and benefits that federal employees or those elected to Congress receive.

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