Stranded in SwampCare: "... A huge part... of the health-care dollar is diverted to bureaucrats, compliance officers, administrators, CEOs, managed-care profits, middlemen such as pharmacy benefits managers, and other swamp dwellers who contribute nothing to the actual care of patients. Then a goodly share goes to lobbyists and congressmen to keep the racket going".

• Author: Orient, Jane M.
• Position: MEDICINE & HEALTH

The swamp in Washington, D.C., and its crony capitalist retainers do not want to lose their grip on the trillions of dollars that slosh through the health care sector--now approaching one-fifth of the U.S. economy.

The one thing that would cut costs (not just spending), restore sanity, protect the patient-physician relationship, unleash innovation, and encourage excellent care is to put patients in control of their own money. Under the current third-party payment system, made much worse by ObamaCare, a huge part (one-third? one half? who knows?) of the health-care dollar is diverted to bureaucrats, compliance officers, administrators, CEOs, managed-care profits, middlemen such as pharmacy benefits managers, and other swamp dwellers who contribute nothing to the actual care of patients. Then a goodly share goes to lobbyists and congressmen to keep the racket going.

There are two disruptive innovations that threaten the sweetheart deals in the swamp: HSAs (health savings accounts) and DPC (direct primary care or direct patient care).

HSAs give individuals spending their own money the same tax advantages long enjoyed by employer-owned health benefits plans but, from the very beginning, they were crippled by restrictive regulations concerning funding and use of the funds. For example, the accompanying "high-deductible health plan" has to have a deductible that is not too low, and not too high, but just right.

DPC is a direct arrangement between doctors and patients, which cuts the red tape out of medical care, kicks the bureaucrats out of the exam room, and is set to sweep across the U.S. whether the swamp likes it or not. Marilyn M. Singleton, president-elect of the Association of American Physicians and Surgeons, explains: 'The DPC model is burgeoning as patients yearn for quality time with their doctor at an affordable price. Here, all primary-care services and access to basic commonly-used drugs at wholesale prices are included in a fixed transparent price," often around $50 to $75 per month.

At present, patients have to pay their monthly DPC membership fees with after-tax dollars. They already have lost 15% of their earnings to the payroll tax, the heaviest burden borne by low-income workers. Workers who have an employer-owned health plan have hundreds of pre-tax dollars extracted from their earnings to go to the third-party payer. (It only looks like the employer is paying--the worker earned the money.) So, health plans, which sell...