The healthcare sector should be organized into two divisions: Primary Care and Specialized Care, enhancing the quality of services, improving patient health outcomes, and lowering healthcare costs for consumers.
PRIMARY CARE
The proposed Primary Care division (PCD) would include imaging and lab services, primary care doctors, urgent care clinics, and standard medications. Consumers would pay directly for these offerings. The government would issue a debit card to the needy for Primary Care.
The current breakdown of total healthcare spending for PCD offerings in the US is: Imaging 17%, Labs 12%, Primary Care Doctors 5%, Urgent Care 5%, and Standard Drugs 6%. This is about 50% of the total healthcare expenditure, or about $6,262 per person each year.
Insurance premiums would be cut by half, saving individuals $2,600 and families $7,444 per year. Consumers could use these savings to pay for PCD offerings. This change would end surprise bills, provider network restrictions, authorizations, claim denials, and poor customer service frustrations.
PRIMARY CARE HELPED BY TRENDS
Imaging and lab equipment is becoming smaller, more automated, and cheaper. Doctor's practices are increasingly conducting on-site lab tests.
Primary care visits are about $100 per visit. Fast growing Direct Primary Care practices offer memberships for $70/month, promising longer patient interactions and on-site vaccinations, drug dispensing, and lab tests.
There are 9616 Urgent Care Clinics (UCCs) compared to 6129 hospitals and growing. At UCCs, 70% of patients wait less than 20 minutes, and 85% are treated in under an hour. Many UCCs operate 24/7 and are adding diagnostic equipment like ultrasounds and X-rays. UCC visits are $168/visit verses ER visits which are $2,200/visit.
As pharma retailers compete for customers, middlemen in the drug industry will become obsolete and prices will decrease rapidly. Consumer will choose equivalent generics instead of 45% opting for brand name drugs today.
SPECIALIZED CARE
Specialized Care would consist of all offerings not part of Primary Care Division will be covered by a new type of healthcare insurance. Consumers would buy this insurance directly from commercial insurance companies on competitive state marketplaces like the ACA/Obamacare.
Centers for Medicare & Medicaid Services will oversee Specialized Care similar to how they oversee Medicare Advantage. Specialized Care plans will provide the same benefits as Original Medicare (Part A and Part B) and Specialty Drug Coverage (part D) - excluding PCD offerings.
Private insurers will administer the plans and set premiums. These Insurers cannot deny coverage or charge more due to pre-existing conditions. They must allow all providers covered by original Medicare.
Employers would pay a new FICA payroll fee amounting to what they currently contribute for health benefits, 7.6% of private employer compensation. The payroll fee and premiums will exceed Specialized Care spending.
More to come...