Restoring the Doctor–Patient Relationship in Healthcare

RALPH NOTE: This is a very good article by Bob Moffit of the Heritage institute. In particular, I have pasted the last 1/3 of his article below:

Restoring the Doctor–Patient Relationship. For their part, the doctors and other medical professionals must do whatever is in their power to make the right diagnosis of the condition to be treated and prescribe the right remedy at the right time to cure disease. Doctors should be the key decision-makers in the delivery of health care, and if they are not the key decision-makers, policymakers need to make sure that they become the key decision-makers in the system.

That is where patients come into the equation. If doctors control the delivery of health care, patients should control the financing. So the key ingredient in creating a value-based health care system would be to transfer direct control of the flow of health care dollars to individuals. This would create a patient-centered, consumer-driven system. It would be the kind of system, based on real choice and robust competition, that would deliver what is of value to the patient, not value defined by either government officials or third-party administrators. At the end of the day, value in health care for an individual patient in a clinical setting can only be determined by that patient in direct consultation with his physician based on the best available information and informed consent.

Systemically, in both the public and the private sectors, we are far from that kind of a common-sense arrangement. Patients do not control the financing of health care. America’s households, not government officials or employers, already pay 100 percent of health care costs, but America’s households control only a tiny portion of total health care spending, mostly in out-of-pocket spending for health insurance which is purchased on their behalf and designed by third parties: employers, managed care executives, or government officials.

Those who control the dollars are those who call the shots. Ideally, individuals and families should control every red cent spent on health care as they do in virtually every other sector of the economy, where consumers make an exchange of dollars for goods and services of value to them.

The Fruits of Patient Empowerment

What would such a new approach mean for doctors and patients?

First, it would mean much greater personal choice over health options in both the public and the private sectors. In the public sector, it would mean that retirees would, for example, be able to carry their private health plans with them into retirement and secure a generous government contribution to offset their cost. In the private sector, individuals and families would have the opportunity, if they wished to do so, to own and control their health insurance policies, just like they own and control their own auto, life, and homeowners insurance, and be able to take their policies with them from job to job without a tax or regulatory penalty.

Second, it would mean much greater patient control over the financing of health options. Individuals would be able to buy the plans they want, the benefits they want, and contract with doctors and other medical professionals for the services they want at a price they wish to pay. This means that individuals would be able to pick health plans that provide them value for their dollars; they would know the price of medical services, and they would be able to compare performance and quality in an information-driven market.

Third, health plans and doctors and other medical professionals would compete on a level playing field. Government would not be in the business of picking winners and losers, setting different rules for different plans and groups, or encouraging or discouraging the marketing or promotion of different health care options.

Finally, individuals and families would be able to pick health plans and medical professionals that support or at least accommodate their ethical, moral, and religious convictions. That is especially important in sensitive matters dealing with the beginning and the end of life.

—Robert E. Moffit, Ph.D., is Senior Fellow in the Center for Policy Innovation at The Heritage Foundation. This lecture is based on his September 23, 2010, presentation to members of the Senate Republican Policy Committee at a session chaired by Senator Charles Grassley (R–IA), Ranking Member of the Senate Finance Committee.

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