This proposal is a radical departure from healthcare options currently available. I will discuss difficult truths and difficult trade-offs. Also, the ideas I present have not been vetted by or endorsed by my family physician colleagues. Maybe some will agree with me; I’m sure some won’t.

I propose that people have a new option for their healthcare they’ve never had before — to be able to drastically transfer their resources away from healthcare to other aspects of their life to improve their health and well being. This plan is for people who believe good health doesn’t just come from pills and MRIs. This plan is for people who believe their lives are healthier if they have secure jobs, live in safe neighborhoods, and who don’t have to live paycheck to paycheck.

Basic Healthcare will succeed where other plans have failed because it will directly attack the root causes of inefficient expensive American healthcare — risk avoidance and runaway costs.

• The participant in Basic Healthcare voluntarily puts herself into an insurance pool of people who are willing to accept less aggressive healthcare in return for less expensive healthcare.

MEDICAL NECESSITY

Every commercially available health insurance plan uses language to explain its benefits as something like all “medically necessary” care. The contract between an insurance company and a policy holder is that any medical care will be provided no matter how rare the benefit or costly the care (within certain total limits). Policy holders take these expectations into their doctors’ offices.

Basic Healthcare will entail a different set of expectations of what services are truly medically necessary, and will be appropriate for people who agree to the following assumptions about the doctor-patient relationship:

• Some tests and treatments commonly recommended by the Government Industrial Medical Coalition (GIMeC) won’t be appropriate for Basic Healthcare patients, either because the risk of the condition in question is too rare for a test or treatment to be justifiable, or more commonly because there isn’t proof that identifying the risk early will make a difference later. The medical directors of the Basic Healthcare plan will develop diagnostic and treatment guidelines to set a level of accepted risk from not receiving rarely beneficial tests or treatments to be similar or less than the risk of injury or death accepted by people who drive cars.
• Before a doctor recommends a certain test or treatment, a minimal level of proof in the scientific literature must support the benefit of the intervention in question. Expert opinion by a group of ologists, without solid scientific evidence to back it up, won’t be enough justification for the doctor to order most tests or treatments. Exceptions could be made for rare life-threatening diseases that by virtue of their rarity have little research to inform physicians on the best options. However, minimal proof doesn’t mean only FDA-approved indications. Much high-quality published medical research describes uses for drugs and devices that haven’t gone through the formal FDA approval process.
• Some tests or treatments that could possibly benefit a person won’t be provided because they aren’t cost-effective.
• When making decisions for their patients, doctors will take the general approach of: when in doubt, don’t.

Other attitudinal differences between doctors and their patients will include:

• Life means more than being kept alive by machines; quality matters.
• Many treatments physicians commonly offer their patients don’t save lives; they delay death.
• If God wants to miraculously heal an individual, He doesn’t need man’s machines to do it.
• Experimental treatments will not be covered, because it’s not fair to the other members of Basic Healthcare for their resources to be taken from them to provide expensive treatments that probably won’t work for an individual patient.

People who choose Basic Healthcare do so with the understanding that the Family Medicine Care assumptions apply and would add to them as follows:

• Early detection doesn’t prevent very much and some proven interventions only rarely make a difference — Approaches to prevention would be adjusted to accept a low level of risk. Examples would include less frequent Pap smear testing and changing diagnostic and treatment goals for high cholesterol. Doctors and patients would allow time for vague symptoms to mature before some tests are ordered or treatments begun.
• An ounce of prevention costs a ton of money
• Ologist care also needs limits — The ologists’ decision making would also be constrained by cost considerations.

END RESULT

The overall cost of healthcare would eventually decrease about 20% further than Family Medicine Care for people who choose Basic Healthcare. This would result in about $3,207 more per year of personal income for a family of four for a grand total of $6,414 more personal income (Family Medicine plus Basic Healthcare changes). For a couple on Medicare, it would mean about $4,232 more per year for a grand total of $8,464 income per year if they both chose Basic Healthcare. This would translate to a total of $705 per month in extra income–from an average in 2009 of $1,913 per month to $2,618 per month.

Under Basic Healthcare, even more resources are available for families to cover health needs outside the formal healthcare system.