Wednesday, September 9, 2009

Curing The Medically Uninsured Problem

The conflict between American’s innate beliefs in capitalism, self-reliance, and individualism with our desire to improve the lives of those around us has never been better epitomized than in our struggles to solve the problem of the medically uninsured. To some, health care is a right, to others it is goods or service. However it is viewed, it is clear that it will never be cost-free.

The Obama Administration, like numerous previous ones, has set its sights on solving this situation. The current set of proposals differs only slightly from its predecessors in that it relies upon the heavy hand of government to effect a cure. Unfortunately, there is little prior evidence that instituting a set of negative incentives, such as increasing taxes and/or rationing care and/or limiting access will have any greater degree of success than other governmental attempts at fixing other problems using its legislative might.

There is, however, another way to care for the uninsured using one of the greatest traits of Americans and America, charity. I recommend that we allow physicians, hospitals, medical device makers, pharmaceutical companies, and other allied health professionals and corporations to deduct from their taxes the care, services, equipment, etc., they provide to the uninsured.

The total amount could be limited to perhaps 10% of gross income based upon a fair valuation of either time spent or the costs of the materials provided. At the physician level – assume the average income of a doctor is $200,000.00 a year; the maximum deduction would be $20,000.00. Assuming an hourly rate of $200.00, that would provide the uninsured with 100 hours of care by that one physician. Cumulatively, that would provide the uninsured with tens of millions of hours of care which is office based and personalized. If the average patient consumes five hours of a physician’s time per year that would allow each doctor to care for twenty uninsured Americans on an annual basis. This would hold true for allied health care personnel, such as physician assistants, licensed nurses, etc. With over half a million physicians and several million allied health care personnel, the potential exists to provide medical care to tens of millions of uninsured Americans.

The same would hold true for pharmaceutical companies, medical device manufacturers, specialty care providers such as radiology concerns, hospitals and other facilities. In short, the entire health care system would be made available to the uninsured comparable to that which the insured enjoy.

This could be extended to medical insurance companies that could offer low cost catastrophic medical insurance policies to the uninsured, for which they would be allowed an income tax deduction to cover apportion of the cost.

It will take much effort to determine what medical criteria are to be used to define an individual as medically uninsured. The amount of income tax deductions allowed to a service provider will vary too.

There is always the fear of fraud. Unhappily that exists whenever there is the potential for inappropriate behavior. Here, the fear of punishment by the IRS weighs as a counter balance.

Every aspect of American health care can be extended to the uninsured using this model. Unlike the downside risks inherent when the government uses its heavy hand as currently being debated with current proposals, here the risks are almost nil. Using the figure of 10% of gross income as a deduction limit and extending that to the industry as a whole, with health care generating approximately $3 trillion in GDP makes the maximum cost of this program $300 billion. The program could be easily canceled without much ado since there will not be any real changes in the system itself.

If the goal is truly to take care of the uninsured this model presents an alternative with limited cost, with no risk to those currently insured, with no significant financial consequences or burdens on the Federal government, while harnessing one of the greatest traits of America and Americans.

David H. Berman, MD, FACP, FACG
President, Park Avenue Medical Professionals, P.C.
Manhattan, NY

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