5 Winners! Physicians' Best Ideas to Replace the ACA


May 15, 2017

In This Article

Paul M. McNeill, MD, Vascular Surgeon
Frederick, Maryland

Paul M. McNeill, MD

Highlights of Dr McNeill's plan include:

  • Three segments of care: catastrophic care, primary/noncatastrophic care; primary/Medicaid

  • Primary/Medicaid care only in employed settings/clinics

  • Trim patient deductibles

  • Allow insurance company profit, but cap the percent of profit, to lower premiums

Dr McNeill's Plan:

I would recommend three segments of care

  1. Catastrophic care (define what this means according to risk and cost of care)

  2. Primary/noncatastrophic care

  3. Primary/Medicaid

Establish catastrophic care as a federal program, removing it from the responsibility of private insurers. This should lower the exposure for those companies and therefore lower the premiums they currently justify.

Establish primary, noncatastrophic care as the domain of private insurance. Premiums for this should be much lower than currently if the insurers do not have to cover catastrophic care. Get the government out of primary care.

Establish primary/Medicaid care in a clinic setting of employed physicians and providers. Have these clinics function like the VA system where patients can come in to the clinic for care instead of going to an emergency department, a Medicaid physician, or not getting care. Employed physicians and providers can be paid a salary vs traditional medical billing and collections. I believe this would lower the cost of care. The government could purchase blocks of services for these patients at negotiated rates for diagnostic testing and interventions. Perhaps the government can team up with hospitals to establish such clinics.

Taking Medicaid fee-for-service primary care out of government would save money that could be directed towards catastrophic care.

Taking catastrophic care out of private insurance would lower their exposure and allow for lower premiums.

Patient deductibles must be trimmed significantly.

Establish a model for insurance company profit that is fair but capped to allow for lower premiums.

Congratulations to All the Winners!

Medscape hopes that Congress will pay attention to the advice and suggestions from these frontline members of the healthcare profession and come up with a plan that addresses the most pressing issues in healthcare.


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