The time is here to think differently about healthcare. There is physician burnout, administrative overload, a shortage of resources, both human and otherwise, and the costs are uncontrolled.  At the same time technology is changing how we evaluate and treat nearly all disease, and at a lightening pace.  We need a new paradigm – one that fits the future of healthcare not its past – and the time is now.

For the past 50 years, employers and the government have been responsible for paying for the majority of healthcare.  However, it’s our pay that is withheld and taxed, our copay that is paid and our deductible that is collected. Whether it’s urgent, elective, or even emergency care none of it is completely covered any more.  We have to face the facts: the patients are the payers and with whom we need to negotiate. 

Admittedly, employers and insurers are easier to contend with.  There is an economy of scale where so called risk can be shared. But there is also a tremendous need for constant data collection to determine those costs and predict which diseases will require the most resources.  This data is approximate at best because it is collected on the premise that we fully understand risk and outcome, so called evidence-based medicine.  But as anyone in practice can attest, we are wrong about patients a good percentage of the time.  Patients with aggressive tumors outlive their disease, while others succumb at an early stage.  Artificial Intelligence can help us better understand what we thought we understood, but data alone cannot predict a patient’s individual response to treatment. If we negotiated with individual patients, doctor to patient, we wouldn’t need to share that patient’s information with a third party, and the cost of their care would be specific to their own disease and individual outcome. All of this data collection becomes less important, making it easier to protect patient privacy, while alleviating significant administrative burden.

However, when the patient becomes the payer, the price needs to be transparent. Because illness is unpredictable, people will always require insurance, but the type of coverage changes.  In an ideal world, patients should be able to pay into a system where the cost of care is predictable. Even the cost of a worst-case scenario can be estimated.  Thanks to ICD10, nearly every possible event is categorized. Health savings accounts, properly funded, may in fact be enough. In countries where national healthcare works, routine care is paid out of pocket and only the big expenses, like trauma or childbirth, are covered by the government. Individuals paying for their individual needs is logical, but the price has to be fair and realistic. It is also consistent with patient privacy and choice.  Even the poor can be given the freedom to access individual care through federally funded HSAs or health vouchers. It would be simpler for everyone and when the patient pays the price comes down.

Requiring price transparency is an important step toward moving the system closer to where medicine is headed.  Gone are the days of long hospital stays, inpatient elective surgery or hospital cased cancer care.  Bernie Sanders had a heart attack, was treated, released, and back to campaigning within a week.  The cost of his cardiac stent is irrelevant because the cost of delivering his care was minimal.  He recuperated at home, not unlike the cancer patient who receives therapy from a pill, often designed for them, taken at home rather than at a cancer center.  Add in remote patient monitoring and telemedicine capabilities, the efficiency improves as the cost diminishes.  This is the future and it is entirely affordable.

It is time to entertain new solutions to healthcare. Rather than continue to look for ways to pay for services no longer necessary, we need to clear our history, and find flexible options that better fit individualized medicine.  Perhaps we won’t need to collect individual patient data, if we can achieve the same goal by anonymizing it. Allowing patients direct access to care and through a transparent price will restore the proper alignment of incentives. Finally, allowing physicians the freedom to focus on their individual patient‘s outcome rather than the priority of a system, will undoubtedly reduce stress and keep us all in practice a little longer.