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Each new government intervention in health care over the past two generations has dehumanized care and accelerated costs. A new rule proposed by U.S. Health and Human Services expanding health reimbursement arrangements (HRAs) can help reverse this trend by promoting patient-directed care.

Since World War II, most working-age Americans have funded their health care through an opaque third-party impersonal corporate structure, with little to no discipline from market forces. This payment structure has morphed from traditional insurance for rare health care events to essentially pre-paid health care funded by pre-tax dollars not paid to employees as wages. 

In 1965, federal and state governments adopted a similar third-party payment system in the form of Medicare and Medicaid. Costs for these programs have exploded, blowing up state and national budgets and crowding out spending on education and infrastructure.  

In addition to these inflationary third-party payment schemes, two laws have greatly diminished the doctor and patient relationship. First, the 2009 Health Information Technology for Economic and Clinical Health Act, has forced untested, government “certified” and clumsy electronic health records on the profession at great cost. This mandated requirement has led to doctors spending about half their time behind computer screens and away from direct patient care.

Second, the 2015 Medicare and Chip Reauthorization Act (MACRA) demanded even more impersonal tasks from physicians, including using unreliably simplistic computer algorithms, evaluating the quality of the medical service, and noting how the provider would be accountable for the outcome. 

This style of bureaucratic medicine imposed by Congress has had many negative effects, including an epidemic of medical errors, patient dissatisfaction, physician burnout and increased physician suicides.

Thanks to the new reporting requirements, physicians have less time to discuss healthy behaviors and elicit clues from accurate medical histories and physical exams. As a result, there’s an increased reliance on excessive testing that’s driving up costs, from which patients are somewhat insulated thanks to the opaque bureaucratic third-party system.

Medicine must be a personal and intimate experience. Any remedy to our health care dilemma must reduce third-party payers and regulations that come between the doctor and the patient. Such reform would reestablish a therapeutic patient-physician relationship, where patients have direct control over their health care dollars.

To help bring down costs and humanize care, all employees should have the option of receiving pre-tax employer deposits into expanded health savings accounts, which would allow patients to pay cash for most care.

Those with no employer deposits could receive means-tested federal and state deposits in their accounts. This would assure universal participation and eliminate the various levels of care present in the current system.

A new option for Medicare is depositing funds into individuals’ health accounts enabling cash payments for most items including catastrophic insurance plans. This would eliminate the need for supplemental insurance and their agents such as the AARP, which claims to be a seniors’ advocacy organization, but in reality, gets about two-thirds of its revenue from health insurance sales royalties.

This conflict of interest is likely why the AARP is throwing its lobbying might behind efforts to block a proposed rule issued earlier this year that would eliminate the billions of dollars in rebates that drug manufacturers pay to health insurers and direct those savings to seniors in the for of lower drug prices. The AARP is dependent on these insurance company royalties and insurers are dependent on the drug manufactures rebates. Hence the AARP is opposed to any rule that seeks to do away with these rebates even though it would lower seniors’ costs of drugs. Giving Americans the option of controlling their own health care funds would lead to more humane care for all at far less cost.  

Dr. Kenneth Fisher is a nephrologist in Kalamazoo and author of “Understanding Healthcare: A Historical Perspective.” He is an advisory board member of Practicing Physicians of America and a member of the American College of Healthcare Trustees.    

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