Many readers correctly have made the point that criticism of the Obama health bill should be accompanied by suggestions for an alternate or better plan. While this writer does not expect you to read the entire 1,018 pages of HR 3200 he asks Whether you think the following 775 word plan might be more palatable.

The current strategy during the August recess was outlined by Paul Begala, a Democrat strategist close to the White House: "Supporters of reform have to put the status quo on trial" .

The Association of American Physicians and Surgeons (Disclosure: This writer, although not a member of AAPS, is Senior Advisor to AAPS for the Take Back Medicine Project) does not support the status quo, but over years and decades has advocated fundamental reforms that:

• Impose no new net burdens on the taxpayer;
• Do not hasten the bankruptcy of federal and state governments;
• Create no new bureaucracies or stakeholders;
• Involve no expansions of government or additional accrual of unconstitutional powers.

AAPS supports reforms that:

• Improve the quality of care by encouraging innovation;
• Allow physicians to concentrate on healing rather than constantly changing administrative rules of thousands of pages;
• Restore the patient/physician relationship and the joy of helping others;
• Increase supply, availability, and competition, and thus decrease costs and make it easier to serve those who are most in need of help;
• Discourage frivolous or predatory litigation. Reform can begin immediately at the individual level, as physicians quit participating in third-party arrangements, and patients fire health plans that insist on intruding into the patient/physician relationship. Specific desirable legislative changes include the following:

   

  • The freedom of patients and physicians to choose or decline to enter relationships on mutually agreeable terms for medical services must be guaranteed. This amounts to keeping the promises made, and codified into law, when Medicare was enacted. It is also in the spirit of Obama's promise that people could keep their health plan and their doctor.
  • The determination of insurance reimbursements must be separated from the determination of fees:

  
  Reimbursement involves insurer and subscriber, and the professional fee involves the patient and the professional. (i.e. value-based payment, with patients determining the value).

   

  • Tax discrimination must be ended. Under current federal tax code, all medical services paid for through employer-owned insurance policies are purchased with pre-tax dollars, while individually owned insurance or out-of-pocket payments must be made with after-tax dollars.

    Eliminating this inequity should decrease both expenditures and actual costs by eliminating over-insurance and thus excess demand for services of marginal benefit, and by encouraging direct payment at the time of service, without the administrative overhead that inevitably accompanies third-party payment.

  • The McCarran Ferguson exemption that protects the business of insurance from antitrust law should be repealed. Monopolies and cartels increase prices; competition drives prices down. The insurance industry should have to operate under the same rules as other enterprises.
  • Barriers to market entry should be removed. These reduce access and increase prices. Anti-competitive barriers include certificate-of-need requirements.
  • Americans should be allowed to purchase insurance across state lines. Residents of states such as New York and New Jersey, whose state mandates have made individual policies prohibitively expensive, could buy a policy in Nebraska or another state with a reasonable regulatory regime. Rep. John Shadegg (R-AZ) has introduced such legislation.
  • Government insurance benefits should be paid to the beneficiary, through a dual-payee check, instead of directly to the provider.

    This change would virtually eliminate fraud from providing fictitious "services" to nonexistent beneficiaries, and would involve beneficiaries in the scrutiny of all bills.

  • Medical professionals, and all Americans, should be protected against seizure, including the court-ordered seizure of their property for the private benefit of plaintiffs and their lawyers, beyond just compensation for actual damages.

  
  Subjective "pain and suffering" and punitive damages are the equivalent of criminal fines; they should be subject to an appropriate higher standard of proof and should be paid to the state, not the lawyer.

  
  Applying the equal protection of the laws to plaintiffs and defendants should decrease predatory or frivolous litigation, and thus decrease excess costs from defensive medicine.

  
  It should also stimulate the development of other means of protection against bad medical outcomes, including better disability insurance purchased by patients. There is no way 500,000 practicing physicians can pay the malpractice insurance for 300,000,000 patients. It is irreconcilable with the entire theory of insurance. We should also consider specialized Health Courts.

  
  A coalition of state and specialty medical societies has drafted a letter to Congress espousing a patient-centered system rather than a government-controlled system.

  
  These are the right kind of changes from the status quo. There is no reason Americans should have to choose between one (The Status Quo) or the other (Obamacare).