Can America’s great health care debate be resolved by promoting transparency and fairness for all stakeholders?  Perhaps, but for this to happen, health care reform must be approached from the bottom up, not top down.  As a physician, I propose the following original plan which views health care through the eyes of its end-users.

Suppose medical care providers such as myself were treated like any other businessperson in America.  Suppose we were paid when services were rendered; in other words, payment upon demand.  Since we then would not have to worry about accounts receivable, insurance denials, or collection accounts, our operational overhead would be reduced, as some estimate, by at least one-third.  Much of this cost savings could then be passed from our bottom line along to our patients, the medical care consumer.

But introducing free market economics into our health care system, which is currently heavily subsidized by our government, requires a new way of thinking. One intriguing approach is for Government to become the “payer on demand” for every citizen’s medical bills.

Think of a single payer entity that would function like a national electronic payment clearing network.  Like other major debit card companies, Government would process payment transactions and recoup its outlays at the end of each month, either directly from cardholders or indirectly from the medical plans in which they participate.

How would such a plan work in practice?  What would be its consequences, intended or otherwise?

Let’s imagine a typical health care consumer, named Ms. Patient, who seeks the performance of a medical service, such as a physical examination, from Dr. X.  Upon registering at Dr. X’s front desk, Ms. Patient produces her “HAA debit card” issued to her as part of a theoretical “Healthy Americans Act.”  Her HAA card is swiped and verified as active and legitimate. At the same time, it provides Doctor X with online access to Ms. Patient’s unique web page which contains up-to-date information concerning her health care insurance coverage, as well as a link to her “health information vault” or electronic health record (EHR).

At the end of Ms. Patient’s visit, Dr. X’s assistant plugs in the CPT code (Common Procedural Terminology) for services rendered and generates an itemized bill on the spot.   Both patient and doctor, as well as payer and insurance carrier, concurrently would be aware of the actual costs associated with Ms. Patient’s visit and the financial obligations toward it of each stakeholder.

Here’s where it gets interesting.  Under one possible scenario, Ms. Patient can elect to pay nothing at time of service.  Her medical care provider, Doctor X, still gets paid his entire contracted amount, including any co-pays and deductions, just like a merchant compensated by Visa or Mastercard for a consumer purchase.  There is no need for him to bill anyone, and so, in return for this significant saving of overhead expenses, he contractually agrees to accept a discounted fee for service. Everybody wins, including Ms. Patient, since service was provided at lower cost without worry about paying for it upfront.  (More concerning this later.)

Thus, at the time of the above payment transaction, Dr. X’s account is electronically credited by the Government agency, a single payer entity on a national scale.  Any existing policy would remain in force between Ms. Patient and her current medical insurance carrier, and it would create an obligation for her insurer to “reimburse” the single-payer agency to the extent of their client’s current policy provisions.

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