There’s a big problem with No. 1 on Dr. Susman’s wish list (A 2012 health care wish list. J Fam Pract. 2012; 61:8)—establish a basic universal health care package for every US citizen—Congress would ensure that all the cost savings come from doctors and hospitals.
Once the government gained control, our legislators would have the ability to control physician reimbursement even more than they do now. This would cancel out any possibility of achieving No. 4 on Dr. Susman’s wish list: Pay us what we’re worth. If you doubt that, just look at the fiasco associated with mandatory coverage of contraception/abortifacients.
Here’s what I propose instead:
Step 1 (to be implemented immediately) involves the charitable tax deduction. Because the government mandates that we see Medicaid, Medicare, and TRICARE patients at less than the customary charge, the government should send the physician/practice a charitable tax credit for the difference. Physicians and practices would get a tax break (just like other businesses that do charity work), which would encourage more physicians to see these “low reimbursement” patients. The amount paid by the government for the patient’s health care should be credited as income to the patient, with the tax liability for this income not to exceed a predefined amount.
For the uninsured, the patient and practice would mutually decide what the patient can pay. The difference between the usual charge and what the patient pays is counted as a charitable contribution tax credit for the physician/practice. The practice then files a form with the IRS, documenting that the patient was given “x” dollars of free services. This counts as income for the patient, who may have to pay a small amount of income tax (or receive less Earned Income Tax Credit) because of this.
In Step 2, the president would call for bipartisan groups (1 senator and 2 congressmen from each party). Each 6-person group would serve as a task force, addressing one aspect of health care. There could be one group working on Medicare, one on Medicaid, one on tax credit issues (eg, whether employer-paid health insurance should count as income), etc.
Each group would solicit input from Americans (not just ivory tower university elites) and hold public hearings on its issue, then put forward a proposed solution. This would be a transparent process (no more, “You have to pass the bill to see what’s in it”) that is also bipartisan. The proposed solutions could be tested in one state first, if necessary, before being implemented nationwide. The elected representatives for each group would be held responsible by the voters, both for arriving at a solution and for its success.
This could work, but it would take leadership, which I would not expect from the current administration.
William Laurence, MD
Fort Bragg, NC