New ideas are always good.  The health care reform debate often rehashes ideas from bygone plans (maybe with a new twist on an idea for a change in semantics, not a bad thing since the ideas have been more fully vetted).  However, unique ideas are always more fun to consider.  Consider this one from Dr. Benjamin Brewer’s Wall Street Journal column last week:

Looking at the way the government is doling out money these days, I have a proposal to help improve people’s health and our system of care. What if the government gave each person $365 of their tax money back to be spent on primary health care?

That amount could be paid directly to each person’s primary care doctor for a year’s worth of services. Imagine if everyone in America could contract privately for medical care for themselves with a primary care doctor without government or insurance company red tape.

The patient would choose the doctor. The basket of services would be predefined, and the price would be locked in for a year, paid as a monthly subscription like cellphone service or movie rentals.

Money spent that way would cover a lot of preventive health, office visits, management of chronic diseases, email contact with the doctor, and after-hours advice. Make it tax deductible for individuals as well as businesses.

Some rough math:

  • 633,000 physicians in the United States x 40.4% working in primary care (according to the Bureau of Labor Statistics, 2005 data) = 255,732 primary care physicians (family medicine and general practice, internal medicine, OB/GYN, pediatrics)
  • 305,688,830 people currently live in the U.S. x $365 primary care tax rebate earmarked for primary care services = $111,576,422,950
  • $111,576,422,950 / 255,732 primary care physicians = $436,302 per physician to pay for the basket of services provided
  • Nurse practitioners and physician assistants (or anyone else) are not included, there are part time physicians to consider as well
  • Anyway, it isn’t enough to sustain a practice but it certainly seems that such a policy may have some impact

Interesting.  Also wonder if such an idea would pave the way for universal primary care?  That certainly opens a whole different can of worms.  Thoughts?

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