The following is an excerpt from Dr. Carson’s book, One Nation: What We Can All Do to Save America’s Future As a doctor, I believe I have acquired some wisdom that can be applied to our need for a well-functioning health care system for the nation. The agenda needs to be the health of the people as opposed to a political feather in a cap, and being a doctor, I would make that a priority more naturally than would a politician. Unfortunately, the Affordable Care Act was more of a victory for the Obama administration than for the American people. In order to have good health care, you need a patient and a health care provider. Originally, the middleman facilitated the relationship between a person and their doctor, but now the middleman is the primary entity, with the health care provider and the patient at his beck and call. The middleman gains financially by denying health care to clients, even when they are supposed to be facilitating the health care process. The whole system is upside down and it is no wonder that it is dysfunctional. If we are to reform the system, we must know what the overriding goals of reform are. First, not only do we need to stop the rapid rise of health care costs, we need to decrease these costs. Second, we need to make sure that everyone has access to basic health care. Third, we need to restore the doctor-patient relationship and put patients back in charge of their own health. (These are not given in order of importance.) As I said at the National Prayer Breakfast, I believe everyone should have a health savings account (HSA) and an electronic medical record (EMR) at the time of birth as a first step toward reform. The EMR should only be in the patient’s possession in the form of an electronic chip embedded into a card or device that can be shared with a health care provider at the patient’s discretion. It would not be available to the IRS or any other governmental agency, and the database would of course need to be as secure as possible to protect personal information from hackers. The HSA could be populated with funds supplied by an employer, the owner, relatives, friends, and governmental sources. Since we already spend twice as much per capita on health care in America as does any other country in the world, even if we put substantial monies in everyone’s HSA, there’s a strong possibility that our shared national health care cost would still decrease. Because there are many responsible individuals and employers who would be willing to contribute to the HSA’s, it would only be necessary for the government to make contributions in the cases of individuals incapable of making a living. In Singapore, the government deducts regular contributions to the medical savings accounts from each worker’s paycheck. Singapore is capable of providing excellent medical care for all citizens for less than a quarter of what we pay. With each person owning his own HSA in the United States, most people would become interested in saving by shopping for the most cost-effective high-quality health care plans available. This would bring the entire health care industry into the free-market economic model resulting in price transparency and creating a system where services and pricing are more closely related to value. In our current third-party insurance-based health-care payment system, it would not be unusual to find a hospital in one part of town that charges $66,000 for an appendectomy while in the same city another hospital charges only $14,000 for the same operation. Since a third party is responsible for the payments, the patient doesn’t really care which of the two hospitals is used, and spends an unnecessarily large amount of money. Approximately 80 percent of all encounters between the health care provider and the patient in a system where HSAs are widely used would be covered by the private account with no need to involve a third party. Since most of the relationships would be doctor-patient relationships, the doctors certainly would not order things without regard to price, and patients would not permit excessive depletion of their HSA’s by careless expenditure. With everybody becoming cost conscious, price transparency would be of paramount importance and fair competition would cause prices to be consistent and reasonable. It is natural to ask what happens if a man needs an operation and does not have enough money in his HSA to cover the cost? The system would be designed in such a way that allows members of his immediate family to shift money from their HSA accounts to his without any penalties. In essence, this would make each family unit its own private health insurance company with no unnecessary middleman increasing costs. I would also make it possible for people to pass the money in their HSAs to family members at the time of their death. This would largely eliminate incentive to spend the money in the account in order not to lose it. A portion of the money in the account could be used to purchase bridge or catastrophic insurance, which would be relatively inexpensive since it would only be used for those 20 percent of cases too expensive to be covered by the typical HSA account. This would work in a manner similar to homeowners insurance that has a high deductible. If that homeowners insurance was used for every type of repair needed on the home with little or no deduction, the cost would be astronomical. Since it is used only for major and expensive home repairs and because routine repairs are taken care of primarily by the homeowner, the cost is reasonable. The HSA accounts would only be for bona fide medical purposes and the money could not be borrowed and/or legally used for any other reason. Special precautions would be in place to oversee the accounts of addicts and other people who have proven themselves to be fiscally irresponsible. In the case of individuals who are mentally incapacitated, a trustworthy family member would likely be appointed as guardian of their HSA account. It could also be made possible for any adult to donate up to a certain predetermined amount of money from their account to any other person’s account for charitable reasons. This becomes an easy way for churches and other organizations to provide charity care at their discretion. It also would encourage those people with massive amounts of money in their accounts to think charitably toward others. This system would put people back in charge of their own health care, bring down costs, and eliminate massive regulatory bureaucratic nightmares for both patients and providers. Tort reform on a national basis would be an essential part of this plan. When doctors have to practice defensive medicine, some procedures are done and tests are ordered purely for medicolegal reasons. Virtually every other nation in the world has figured out a way to take care of patients who suffer as a result of attempts by medical personnel to help them. I practiced in Australia for one year as a neurosurgeon, and my malpractice premiums were only $200 a year at that time. Compare this with the $300,000 malpractice insurance fee assessed on a litigation-free neurosurgeon in Philadelphia today. The quality of neurosurgical care in Australia was excellent just as it is in America, but at that time it was difficult or impossible to bring a medical malpractice lawsuit against someone on a contingency basis. In other words, you had to take money out of your own pocket in order to sue someone, which meant you were unlikely to do that unless you had a very good case. In our system you can sue and pay little or nothing while engaging in activities that might make you a millionaire. It certainly should come as no surprise to anyone that certain lawyers and patients alike would want to take advantage of such a medical lottery. We need to have a national system that allows immediate and appropriate compensation for medical injuries. If a particular practitioner is responsible on a regular basis for patient compensation due to inappropriate care, that information would be available as a public record and savvy consumers who were vigilant regarding the distribution of their HSA dollars would be unlikely to frequent such practitioners. Retraining or disciplinary actions might also be easier to enact. This is another example of how the free market can be a positive force in ensuring excellence. I am currently working with other health care providers and legislators to incorporate these ideas into a truly affordable health care plan that is relatively simple and puts patients and doctors back in charge of health care. It is vital that we emphasize the importance of working together in a bipartisan fashion, because sickness and disease have no party affiliation, nor should those who are trying to conquer them. If Obamacare continues to crumble and/or is defunded, no one should gloat or say, “I told you so.” This is not a time to proclaim victory, but rather a time to put aside our differences and solve a difficult problem. In the meantime, I have frequently expressed doubts about the wisdom of imposing a gigantic governmental program like Obamacare without first testing its components. Common sense would dictate a piecemeal implementation of such a massive program since it profoundly affects virtually every American family. As the program is being rolled out, even its most fanatical supporters are starting to see major flaws and losing their enthusiasm for what is destined to be a disaster. Many promises were made about the program including the famous presidential promise that “If you like your current insurance, you can keep it.” On an almost weekly basis we hear about organizations that are dropping or altering the insurance they offer and about health care providers who are retiring or changing the way they practice. This means that millions of Americans who were satisfied with their health care plans now have to make costly and worrisome changes. Many who previously had health care insurance have been demoted to part-time status, so not only do they lose their insurance, but they lose substantial income. The very fact that everyone is looking for exclusions so they don’t have to participate right away should be a red flag to any objective observer. A Vision for a Wiser Health Care System
The following is an excerpt from Dr. Carson’s book, One Nation: What We Can All Do to Save America’s Future As a doctor, I believe I have acquired some wisdom that can be applied to our need for a well-functioning health care system for the nation. The agenda needs to be the health of the people as opposed to a political feather in a cap, and being a doctor, I would make that a priority more naturally than would a politician. Unfortunately, the Affordable Care Act was more of a victory for the Obama administration than for the American people. In order to have good health care, you need a patient and a health care provider. Originally, the middleman facilitated the relationship between a person and their doctor, but now the middleman is the primary entity, with the health care provider and the patient at his beck and call. The middleman gains financially by denying health care to clients, even when they are supposed to be facilitating the health care process. The whole system is upside down and it is no wonder that it is dysfunctional. If we are to reform the system, we must know what the overriding goals of reform are. First, not only do we need to stop the rapid rise of health care costs, we need to decrease these costs. Second, we need to make sure that everyone has access to basic health care. Third, we need to restore the doctor-patient relationship and put patients back in charge of their own health. (These are not given in order of importance.) As I said at the National Prayer Breakfast, I believe everyone should have a health savings account (HSA) and an electronic medical record (EMR) at the time of birth as a first step toward reform. The EMR should only be in the patient’s possession in the form of an electronic chip embedded into a card or device that can be shared with a health care provider at the patient’s discretion. It would not be available to the IRS or any other governmental agency, and the database would of course need to be as secure as possible to protect personal information from hackers. The HSA could be populated with funds supplied by an employer, the owner, relatives, friends, and governmental sources. Since we already spend twice as much per capita on health care in America as does any other country in the world, even if we put substantial monies in everyone’s HSA, there’s a strong possibility that our shared national health care cost would still decrease. Because there are many responsible individuals and employers who would be willing to contribute to the HSA’s, it would only be necessary for the government to make contributions in the cases of individuals incapable of making a living. In Singapore, the government deducts regular contributions to the medical savings accounts from each worker’s paycheck. Singapore is capable of providing excellent medical care for all citizens for less than a quarter of what we pay. With each person owning his own HSA in the United States, most people would become interested in saving by shopping for the most cost-effective high-quality health care plans available. This would bring the entire health care industry into the free-market economic model resulting in price transparency and creating a system where services and pricing are more closely related to value. In our current third-party insurance-based health-care payment system, it would not be unusual to find a hospital in one part of town that charges $66,000 for an appendectomy while in the same city another hospital charges only $14,000 for the same operation. Since a third party is responsible for the payments, the patient doesn’t really care which of the two hospitals is used, and spends an unnecessarily large amount of money. Approximately 80 percent of all encounters between the health care provider and the patient in a system where HSAs are widely used would be covered by the private account with no need to involve a third party. Since most of the relationships would be doctor-patient relationships, the doctors certainly would not order things without regard to price, and patients would not permit excessive depletion of their HSA’s by careless expenditure. With everybody becoming cost conscious, price transparency would be of paramount importance and fair competition would cause prices to be consistent and reasonable. It is natural to ask what happens if a man needs an operation and does not have enough money in his HSA to cover the cost? The system would be designed in such a way that allows members of his immediate family to shift money from their HSA accounts to his without any penalties. In essence, this would make each family unit its own private health insurance company with no unnecessary middleman increasing costs. I would also make it possible for people to pass the money in their HSAs to family members at the time of their death. This would largely eliminate incentive to spend the money in the account in order not to lose it. A portion of the money in the account could be used to purchase bridge or catastrophic insurance, which would be relatively inexpensive since it would only be used for those 20 percent of cases too expensive to be covered by the typical HSA account. This would work in a manner similar to homeowners insurance that has a high deductible. If that homeowners insurance was used for every type of repair needed on the home with little or no deduction, the cost would be astronomical. Since it is used only for major and expensive home repairs and because routine repairs are taken care of primarily by the homeowner, the cost is reasonable. The HSA accounts would only be for bona fide medical purposes and the money could not be borrowed and/or legally used for any other reason. Special precautions would be in place to oversee the accounts of addicts and other people who have proven themselves to be fiscally irresponsible. In the case of individuals who are mentally incapacitated, a trustworthy family member would likely be appointed as guardian of their HSA account. It could also be made possible for any adult to donate up to a certain predetermined amount of money from their account to any other person’s account for charitable reasons. This becomes an easy way for churches and other organizations to provide charity care at their discretion. It also would encourage those people with massive amounts of money in their accounts to think charitably toward others. This system would put people back in charge of their own health care, bring down costs, and eliminate massive regulatory bureaucratic nightmares for both patients and providers. Tort reform on a national basis would be an essential part of this plan. When doctors have to practice defensive medicine, some procedures are done and tests are ordered purely for medicolegal reasons. Virtually every other nation in the world has figured out a way to take care of patients who suffer as a result of attempts by medical personnel to help them. I practiced in Australia for one year as a neurosurgeon, and my malpractice premiums were only $200 a year at that time. Compare this with the $300,000 malpractice insurance fee assessed on a litigation-free neurosurgeon in Philadelphia today. The quality of neurosurgical care in Australia was excellent just as it is in America, but at that time it was difficult or impossible to bring a medical malpractice lawsuit against someone on a contingency basis. In other words, you had to take money out of your own pocket in order to sue someone, which meant you were unlikely to do that unless you had a very good case. In our system you can sue and pay little or nothing while engaging in activities that might make you a millionaire. It certainly should come as no surprise to anyone that certain lawyers and patients alike would want to take advantage of such a medical lottery. We need to have a national system that allows immediate and appropriate compensation for medical injuries. If a particular practitioner is responsible on a regular basis for patient compensation due to inappropriate care, that information would be available as a public record and savvy consumers who were vigilant regarding the distribution of their HSA dollars would be unlikely to frequent such practitioners. Retraining or disciplinary actions might also be easier to enact. This is another example of how the free market can be a positive force in ensuring excellence. I am currently working with other health care providers and legislators to incorporate these ideas into a truly affordable health care plan that is relatively simple and puts patients and doctors back in charge of health care. It is vital that we emphasize the importance of working together in a bipartisan fashion, because sickness and disease have no party affiliation, nor should those who are trying to conquer them. If Obamacare continues to crumble and/or is defunded, no one should gloat or say, “I told you so.” This is not a time to proclaim victory, but rather a time to put aside our differences and solve a difficult problem. In the meantime, I have frequently expressed doubts about the wisdom of imposing a gigantic governmental program like Obamacare without first testing its components. Common sense would dictate a piecemeal implementation of such a massive program since it profoundly affects virtually every American family. As the program is being rolled out, even its most fanatical supporters are starting to see major flaws and losing their enthusiasm for what is destined to be a disaster. Many promises were made about the program including the famous presidential promise that “If you like your current insurance, you can keep it.” On an almost weekly basis we hear about organizations that are dropping or altering the insurance they offer and about health care providers who are retiring or changing the way they practice. This means that millions of Americans who were satisfied with their health care plans now have to make costly and worrisome changes. Many who previously had health care insurance have been demoted to part-time status, so not only do they lose their insurance, but they lose substantial income. The very fact that everyone is looking for exclusions so they don’t have to participate right away should be a red flag to any objective observer. 