5 Winners! Physicians' Best Ideas to Replace the ACA

Disclosures

May 15, 2017

In This Article

Physicians Know What It Takes

Can physicians develop the best way to repeal, replace, or tweak the Affordable Care Act (ACA)? Quite possibly! After all, doctors are intricately involved with all aspects of healthcare and are close enough to see problems, solutions, and aspects of the issue that might not be obvious to others.

The ACA is one of the most contentious issues in healthcare accessibility and delivery. President Trump has vowed to repeal the ACA, and although the American Health Care Act bill has been passed by the House of Representatives, it faces a stiff battle in the Senate.

Medscape believes that the best plan may come from physicians. On March 28, Medscape kicked off a contest asking physicians, "How would you repeal or replace" the ACA? Each of the five winners received a $300 Amazon.com gift card. More than 600 physicians submitted their thoughts and plans for what they consider a viable replacement.

The entries showed an impressive degree of deep thinking, provocative analysis, and far-reaching perspective.

As expected, there are widely diverse opinions as to the plan that would be best for patients, physicians, and the healthcare sector. To be sure, a large percentage of physicians support the ACA. "Fix it, don't repeal it!" was a common battle cry. Many are convinced that the ACA addresses the task it set out to accomplish: Make coverage available to uninsured Americans, and work toward creating less costly healthcare delivery.

A few general themes for a new healthcare plan surfaced from among the entries. A notable percentage of physicians favor a single-payer, national health plan for all. "Put everyone on Medicare: It works great!" was a frequent suggestion. "Medicaid for All!" and "National health system just like in other countries," said some physicians. Other themes included: Enable consumers to purchase insurance across state lines; provide catastrophic care only; stop providing futile care; and implement financial incentives and penalties for patients.

The entries also reflected very different philosophies of healthcare, government, and society. "Isn't it time that we accept the fact that healthcare is a right?" asked one physician. "Healthcare is not a free natural resource, and patients should have to bear some responsibility for their own health," countered another.

Readers' viewpoints also diverged between "more government" and "less government" polarities. Some suggested that the government take over all healthcare, eliminate commercial insurance, and raise taxes to fund the healthcare costs. Others think that a healthcare system should work within America's existing capitalist business system, but we should improve its efficiency and effectiveness without increasing taxes to fund it.

So Difficult to Choose!

A panel of experts in the healthcare field reviewed the entries. There were so many intelligent plans; it was a challenge to choose between many of them! Overall, we looked for plans that, as an ACA replacement, solved or dealt with the problems that the ACA tried to address: how to help uninsured people get medical care while also addressing the rapidly spiraling costs in the healthcare sector.

As one entrant noted, it's impossible to explain a complete plan in 500 words, and we judged plans accordingly.

We also looked to select plans that represented different viewpoints. We considered whether they addressed both concerns and were well thought out. There were a number of near-duplicate plans that centered upon the same premise. In such situations, we chose the plan that seemed more complete or went further in addressing aspects of implementation and cost.

In addition to the excellent plans that won the prize, many entries contained intriguing and innovative ideas that we felt were too good to overlook. We will announce 20 honorable mentions for individual elements of a plan and will publish those honorable mention ideas in the coming weeks.

Medscape does not endorse any of these plans.

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