5 Winners! Physicians' Best Ideas to Replace the ACA


May 15, 2017

In This Article

Al Pokorny, MD, Otolaryngologist
Spokane, Washington

Al Pokorny, MD

Al Pokorny, MD, attended the University of Washington Medical School and trained in otolaryngology at the University of Utah. He then "hung out a shingle" in Park City, Utah, where he was involved in the Utah Medical Association as president of a Utah young physicians group and founding president of the Summit County Hospital Foundation. After 10 years in solo practice, he joined Spokane ENT, a large single specialty private practice, where he specializes in rhinology and allergy. He holds a clinical appointment at the University of Washington. He is married to Valerie Logsdon, MD, has three grown children.

Highlights of Dr Pokorny's plan include:

  • Allow a "true" transparent healthcare marketplace

  • Promote choice based on personal responsibility and patient's perception of "value"

  • Change the role of government

  • Provide the basics for those who cannot pay

Dr Pokorny's Plan:

The current top-down model of competition advocated by the government has created limited choice in healthcare, has not controlled costs, and has not provided value. Government regulation, metrics, and mandates have increased cost with little benefit.

The perception of "value" is in fact an individual one, based on a judgment of cost vs benefit. Currently "nobody knows what 'that' costs," in that individuals cannot shop for healthcare because, until an EOB is issued, they can't know the price. Meanwhile, those who wish to pay cash for healthcare are at the greatest disadvantage because of cost shifting. As government-mandated corporate healthcare has evolved, the individual patient and provider are left with fewer choices as to what care is available and how that is provided. It is a simple concept that in a free society, no one is satisfied when others tell them what they must do or what they can have. It is time to take a step back and rethink healthcare in America.

1. Allow a true "healthcare marketplace" to exist, with transparency.

For all goods and services: All providers must list their charges; all insurances must list their reimbursements; there will be no contractual discounts; balance billing will be allowed for all services.

2. Promote personal responsibility and choice based on individual perception of "value."

Health insurance may only be purchased by families/individuals; a set amount (eg, $10,000), determined by Congress, can be used tax free for health insurance and/or put into an HSA (health savings account). Health insurance will be offered, based on well-defined layers/levels of coverage, including deductibles and co-pays, services covered (eg, drugs, office visits, hospitalizations, obstetrics), cost/benefit analysis (eg, will a drug that adds 2 months to a terminal cancer victim be covered?), thus allowing individuals to share risk with like-minded people. Individuals may purchase insurance from anyone and can seek care from anyone using information guaranteed by #1.

3. Provide the basics for those who truly cannot pay (and a safety net to others, for a price).

Free, or reduced cost, care will be provided by any willing provider for those individuals who qualify, or through government-run institutions. Current Medicaid (and some Medicare) funds will pay for this; in this setting, students and residents may provide "unsupervised" care; no lawsuits.

Prices for drugs and durable goods will be negotiated by the government; care will be rationed; at no cost, Medicare recipients may choose this system.

4. Change the role of government.

Decrease regulation of the free market; be the clearinghouse for information; publish and monitor #1; provide analysis of cost/benefit for goods and services; electronic medical record systems must share data through government-provided conduits.

In this model, costs would spiral downward as providers and drug/device vendors compete for business based on value. Individuals would be given true choices and would be satisfied that they can get what they want, based on their own perception of "value," while not paying for things they don't desire.


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