This is an opinion post Root Cause MDa practicing physician who prefers a holistic, full-fledged approach to restoring health.
RootCause MD has no affiliation with the Oklahoma Surgical Center.
The US healthcare system is a garbage can fire. The US per capita is the largest spender on healthcare in the world, almost twice as much as similarly developed countries such as France, Sweden or the UK. access and quality of health care (HAQ), burden of disease (disability-adjusted life years or DALYs), and pregnancy-related deaths.
What is causing such a discrepancy between health expenditures and health outcomes? This is a complex question. Part of the reason is the brutal diet and lifestyle that has created obesity and chronic disease in the American population at unprecedented rates, but much of the blame lies in a broken healthcare system that fails to provide value to patients.
Many books can and have been written on this complex subject. In my opinion, the main problem is government intervention that reduces free market competition and has crippling consequences.
If a plumber or accountant offers an unreasonably large price or provides poor service, they won’t be able to win the business in progress. This is not the case in healthcare, where cartels of insurance companies and hospitals collaborate to fix prices and maximize profits.
Over-regulation and market intervention by the government has provided fertile ground for regulatory takeover and, as a result, the proliferation of an entire class of profiteers, crooks, and freeloaders who make money between patient and doctor. This rent-seeking “Medical Industry Complex” includes the health insurance industry, corporate hospital groups (including “non-profit” hospitals), and the pharmaceutical industry; all benefited greatly from free market censorship. from practices run by doctors and the wholesale centralization and corporatization of medical care.
This resulted in a horribly misaligned set of incentives and, quite often, a head-to-head issue between doctor and patient.
For physicians, it leads to unnecessary drug use, unnecessary surgery, and ignorance of the best lifestyle medicine that can address and reverse chronic disease at its root cause. It also means a loss of autonomy, as doctors often have to obtain approval from insurance companies before starting care.
For patients, this means obscenely high medical bills, erratic quality, and bankruptcy of “insured” patients when insurance companies refuse to pay medical bills.
How did that happen? For scholars of the Austrian school of economics, such inefficient market dynamics were the inevitable result of a divorce from a solid monetary standard when Nixon closed the gold window in 1971.
Fiat money gave birth to fiat medicine, and distorted incentives led physicians to “first do no harm,” shifting more and more away from the Hippocratic Oath, while presenting a healthcare system that failed patients by prioritizing revenue over quality.
As Marcellus said in Shakespeare’s “Hamlet,” “Something is rotten in the Danish state.”
Anesthesiologist and Austrian economics student, Dr. Keith Smith saw the quality of health care decline and costs rise in the early 1990s. He felt ethically compelled not to participate in a system that often bankrupted patients when they received inappropriately large medical bills.
“In the early 1990s, I was convinced that the Government did not have money that they had not stolen in the first place, and that accepting Government payment was buying stolen goods.” — Dr. Keith Smith
He founded the Oklahoma Surgery Center in 1997, with fellow anesthesiologist Dr. He opened with Steven Lantier with the goal of providing the highest quality of elective surgical care while providing transparent pricing and without funding from the government or insurance companies.
Oklahoma Surgical Center is a pretty unique operation for several reasons:
- They post fully publicly available prices for all surgeries on their website, including surgeon fees, anesthetist fees, supplies, and facility fees.
- More than half of their clients are from out of state, including people who do not have insurance coverage and who would otherwise not be able to afford surgery under an existing insurance plan or have long wait times for elective surgery in their home country.
- They publicly publish post-operative infection rates, an important quality measure that most institutions and surgeons take care not to expose.
- It is fully owned and operated by doctors.
- Most importantly, they operate on a purely fee-for-service basis, receive payments directly from patients (including bitcoin), and refuse to transact with third-party payers.
The results of the surgical center speak for themselves. All-inclusive prices for elective surgeries are usually one-tenth the cost of the local hospital. In some cases, patients have all of their surgeries done at a company-owned hospital for less than the insurance deductible. Most of the prices did not go up nominal Despite two and a half years of inflation since 1997. Many prices have dropped or minimally increased, but larger care packages are more valuable, for example, in the form of post-surgery physical therapy.
Surgeons working in a surgical center have the lowest rates of postoperative infection, and it is not uncommon for patients to be overdiagnosed by an external surgeon at initial examination and be turned away from surgery.
The income of operating surgeons is higher than other institutions, although the center receives patients at much lower prices. This may be because the center operates with minimal profits, often diverting institutional profits to surgeon and staff income. Sometimes surgeons and anesthetists waive their fees for extenuating circumstances on a case-by-case basis.
Over the past 25 years of operation, the Oklahoma Center for Surgery has shown that the free-market care model can significantly reduce healthcare costs while delivering consistently high-quality care. The surprising results can be attributed to genuine free market competition and the elegant alignment of incentives that occur when all intermediaries are removed from the healthcare process, a medical practice is physician owned and operated by the physician, and patients pay directly for a fee. arrangement for service.
This setup ensures that there are no conflicts of interest, profit-driven KPIs, or other financial commitments with insurance, hospital or any other industry that could be biased towards overdiagnosis or overtreatment. Incompetent or unethical surgeons are not offered continued operation rights.
The Oklahoma Center for Surgery can be viewed simply as the physical infrastructure that facilitates the voluntary, free-market exchange of services between a patient and their surgeon. A face-to-face “Silk Road” for surgical care. A proof of concept for a sustainable, high-quality healthcare system for a post-fiat era.
Despite its success, the free market approach to healthcare has many critics. Most commonly, it is the possible loss of access to health care for the disadvantaged and low-income. This argument echoes similar arguments about a bitcoin-standard social safety net. It ignores the more pressing reality that a growing segment of the population can no longer afford to participate in the existing system as it stands, and that the majority will be better off financially on the other side of a solid monetary standard of greater total social wealth. and increase purchasing power.
The question of how to apply the fee-for-service model beyond elective surgery is more relevant. Longer hospital stays, intensive care, frequent procedures or repeated outpatient follow-up represent future challenges that need to be addressed regarding the implementation of free market healthcare.
Most of these issues are currently being resolved. Companies like CrowdHealth use direct-paying operations like the Oklahoma Surgical Center and negotiate on behalf of members to provide health safety nets while bypassing the inefficient insurance industry.
Dr. Smith and Dr. Whether Lantier knows it or not, its operations provide a blueprint for an agentless healthcare system on a bitcoin standard. As fiat currencies swell rapidly, health care costs under the coin system continue to rise, and governments’ ability to continue to effectively fund socialized health care declines, pressure on direct-paying health care is becoming a matter of economic inevitability.
Because Bitcoin separates money from the state, it will also help to separate healthcare from the state. With the decentralized, deregulatory power of bitcoin acting on the social level, healthcare on a bitcoin standard is likely to look very different from today.
Removing nominal incentives should see the bloated Medical Industry Complex shrink as the crowd of bureaucrats, hospital administrators, drug reps, and paper-throwing backroom workers become obsolete by the highly efficient free market that provides high-value care. cost.
I predict that consumers who are directly responsible for the cost of maintenance (paid in bitcoin) will seek a much higher bar for value. Many will seek out doctors who can prescribe effective diet and lifestyle advice that prevents them from needing surgery or expensive life-long prescriptions in the first place. The poor will be direct recipients of philanthropy in the form of waived or crowdfunded doctor’s fees.
In the long run, the system should evolve from a system based on the pharmaceutical management of chronic diseases and surgical intervention after the emergence of pathology to a holistic, integrated approach based on prevention.
As the Oklahoma Center for Surgery shows, free-market healthcare has the potential to deliver massive reductions in cost and increases in quality of care. It’s dizzying to think how abundant, accessible and cheap healthcare can become in the deregulated world of the Bitcoin standard.
This is the promise of an unbroken healthcare system with conflicting economic incentives and financial conflicts of interest. A healthcare system that enables physicians to once again deliver the highest quality, highest value, lowest cost care with the patient at the front and center of the clinical relationship.
Keith Smith, Interview with Russ Roberts of Econtalk on free market healthcare. https://www.econtalk.org/keith-smith-on-free-market-health-care/
By Russ Roberts “Dr. Health Lessons from Keith Smith” https://russroberts.medium.com/health-care-lessons-from-dr-keith-smith-aa29baefbecc
This is a guest post Root Cause MD. The opinions expressed are their own and are owned by BTC Inc. or may not reflect the views of Bitcoin Magazine.