What Republicans and Democrats can do to fix our health care

Anyone watching the most recent round of Democratic presidential primary debates should recognize that in both the first and second sets of debates, all the candidates worked from the assumption that Americans face a binary choice: government-run health care or private health insurance.  Republican responses to the debates made the same assumption.

Big Brother or Big Insurance — love one, hate the other.  That's the anemic range of health care messaging to expect from Democrats and establishment Republicans alike.  The problem?  Both sides are wrong — myopically, expensively wrong.

Democrats insist that you must love government-run health care and hate private insurance companies.  Republicans insist that you must love health care from insurance companies and hate government-run options.

But government-run and private insurer–run health care are both bad options, especially when Democrats and establishment Republicans present them as the only ones.  That's why I choose option three: patient-run health care.  So do my patients, and so do countless other patients across the country — not that you'll hear about them in the debates.  Such patients — many of them low-income — buy health care directly from their doctors for pennies on the dollar compared to what Democrats and establishment Republicans would have patients (or taxpayers) pay for insurance.

Instead of patient-run health care, expect to hear more about its opposite: government (single-payer) health insurance.  On its face, it sure sounds good: free health care!  Who wouldn't like that?

Setting aside the lack of freedom, single-payer lacks funding — because it is impossible to fund without robbing patients blind.  Where does the government actually get its money?  Do you think the rich can cover everyone's care?  Think again.

Because not even America's billionaires could fund it, single-payer wouldn't just take away your freedom — it would eventually (or even immediately) require lawmakers to raise your taxes.  So you would end up paying for a government bureaucrat to strip you of the power to make decisions regarding your own body.

Our current, private insurance–run system also domineers patients — and charges them for it.  Insurance companies are so tied up by federal mandates and regulations that insurers are basically an extension of the government already.  These insurers navigate a byzantine billing process that drives up costs, decreases quality, and corrupts care.

Some argue for the status quo by claiming that Americans love our health insurance companies.  But I've never loved any health insurance company I dealt with — as either a physician or a patient — and I know few people who have had great experiences.  Of those few, many like their insurer simply because they're healthy and haven't used their insurance much.  That means they've avoided the agony of interacting with private insurance companies that serve their own bottom lines first, not the patient's.

Patient-run care is the third option.  I want a system where the government gets out of the way, or at least significantly decreases its footprint in health care.  I want a plethora of innovative insurance options that cover what I want — not what bureaucrats tell me I must buy.  I want insurance that covers the catastrophic events that would truly bankrupt me — not the inexpensive, predictable health care services that traditional insurance complicates.

Revolting against the tyranny of single-payer and removing government regulations of our options can deliver true choice, competition, and patient freedom.  That's what I want, and many others would love to see it, too.  President Trump's recent Heath Reimbursement Arrangements rule and executive order on health care price transparency in June cleared the ground for patient-run health care.

Republicans should focus on this third option instead of making the same assumptions as Democratic presidential candidates.  Democrat and Republican candidates alike should unhitch their wagons from the failed health insurance model and distance themselves from the disastrous single-payer delusion.

Chad Savage, M.D. (info@d4pcfoundation.org) is a policy fellow at the Docs 4 Patient Care Foundation and the founder of the DPC practice YourChoice Direct Care in Brighton, Michigan.

Anyone watching the most recent round of Democratic presidential primary debates should recognize that in both the first and second sets of debates, all the candidates worked from the assumption that Americans face a binary choice: government-run health care or private health insurance.  Republican responses to the debates made the same assumption.

Big Brother or Big Insurance — love one, hate the other.  That's the anemic range of health care messaging to expect from Democrats and establishment Republicans alike.  The problem?  Both sides are wrong — myopically, expensively wrong.

Democrats insist that you must love government-run health care and hate private insurance companies.  Republicans insist that you must love health care from insurance companies and hate government-run options.

But government-run and private insurer–run health care are both bad options, especially when Democrats and establishment Republicans present them as the only ones.  That's why I choose option three: patient-run health care.  So do my patients, and so do countless other patients across the country — not that you'll hear about them in the debates.  Such patients — many of them low-income — buy health care directly from their doctors for pennies on the dollar compared to what Democrats and establishment Republicans would have patients (or taxpayers) pay for insurance.

Instead of patient-run health care, expect to hear more about its opposite: government (single-payer) health insurance.  On its face, it sure sounds good: free health care!  Who wouldn't like that?

Setting aside the lack of freedom, single-payer lacks funding — because it is impossible to fund without robbing patients blind.  Where does the government actually get its money?  Do you think the rich can cover everyone's care?  Think again.

Because not even America's billionaires could fund it, single-payer wouldn't just take away your freedom — it would eventually (or even immediately) require lawmakers to raise your taxes.  So you would end up paying for a government bureaucrat to strip you of the power to make decisions regarding your own body.

Our current, private insurance–run system also domineers patients — and charges them for it.  Insurance companies are so tied up by federal mandates and regulations that insurers are basically an extension of the government already.  These insurers navigate a byzantine billing process that drives up costs, decreases quality, and corrupts care.

Some argue for the status quo by claiming that Americans love our health insurance companies.  But I've never loved any health insurance company I dealt with — as either a physician or a patient — and I know few people who have had great experiences.  Of those few, many like their insurer simply because they're healthy and haven't used their insurance much.  That means they've avoided the agony of interacting with private insurance companies that serve their own bottom lines first, not the patient's.

Patient-run care is the third option.  I want a system where the government gets out of the way, or at least significantly decreases its footprint in health care.  I want a plethora of innovative insurance options that cover what I want — not what bureaucrats tell me I must buy.  I want insurance that covers the catastrophic events that would truly bankrupt me — not the inexpensive, predictable health care services that traditional insurance complicates.

Revolting against the tyranny of single-payer and removing government regulations of our options can deliver true choice, competition, and patient freedom.  That's what I want, and many others would love to see it, too.  President Trump's recent Heath Reimbursement Arrangements rule and executive order on health care price transparency in June cleared the ground for patient-run health care.

Republicans should focus on this third option instead of making the same assumptions as Democratic presidential candidates.  Democrat and Republican candidates alike should unhitch their wagons from the failed health insurance model and distance themselves from the disastrous single-payer delusion.

Chad Savage, M.D. (info@d4pcfoundation.org) is a policy fellow at the Docs 4 Patient Care Foundation and the founder of the DPC practice YourChoice Direct Care in Brighton, Michigan.