I am a practicing family doctor and I know healthcare can be affordable for all Americans. Other developed countries spend half what we do on healthcare with quality at least as good as ours.

As a doctor, every day I see where the money is wasted. I believe I can be an important part of shaping a healthcare system that maintains individual choice, and maintains or improves quality, while at the same time cutting costs to bring care within reach for all Americans.

We must do something to reign in out of control healthcare costs. It boils down to two choices: decrease healthcare spending through government supervision and oversight (also known as rationing) or rely on personal responsibility and choice to decrease unneeded spending.

Right now either choice would be better than what we have currently. I would prefer to see a system that gives individuals incentive to seek high quality care at a low cost (like we manage nearly everything else in our country, from buying cars to buying food.) With our current system we have a bizarre disconnect wherein the people making the spending decisions (patients and doctors) have no real reason to consider if the benefit justifies the cost. There are many healthcare bargains to be had today (generic drugs for example.) Asking our population, the savviest consumers in the world, to curb spending on health care while improving outcomes seems to make the most sense.

High-deductible health plans (HDHP) paired with health savings accounts (HSA) are a good start but some gaps need to be plugged, such as helping high-cost patients by establishing a Catastrophic Health Insurance program. I believe we may need a separate system set up to completely cover high risk patients such as cancer patients. Healthcare costs should encourage good behavior, not punish folks who are afflicted with cancer through no fault of their own.

Health insurance should shift away from what it is now - insurance that picks up many small costs but does not cover all of the large bills. Instead insurance should leave small expenditures as out of pocket expenses and fully cover large expenses. Imagine how expensive our car insurance would be if it covered things like gasoline and oil changes!

We should have a system that offers the same tax advantage to individual purchasers that those with employer purchased plans currently enjoy. There should be an even playing field which would also help to make insurance more portable.

How about reducing healthcare costs through reducing the NEED for healthcare? Over half the dollars spent today in our system are spent to address illness caused by poor quality lifestyle choices. Smoking, obesity, and sedentary habits account for hundreds of billions of healthcare dollars, and countless years of illness and misery. We need to address these habits through an aggressive campaign to stop teen smoking, and to instill healthy eating habits and healthy food choices in our kids. We need to reward positive lifestyle changes in adults with lower premiums and rebates (just as we do with car insurance for safe drivers and drivers that take driving safety classes.) As unpopular an idea as it is, there is no getting around the fact that though our actions we are contributing to our own high cost of healthcare, and individual effort and responsibility is a necessary component in fixing our healthcare crisis.

We also must tackle the looming primary care shortage. Primary care is the best investment for good outcomes, but our system disincentivizes primary care.

I’ll close with this example of waste in our healthcare system:

Medicare Part D was enacted roughly 6 months before many of the nation’s best selling drugs lost their patents and were placed on the $4 cash generic list. As soon as Part D was passed it succeeded in removing any incentive for seniors to find great medication bargains, and instead encouraged them to continue to buy high-priced brand name drugs with tax-payer cash. And to top it all off the law was written to forbid the government to negotiate lower prices. I believe this was the biggest tax-payer rip-off in recent history. I am a practicing family doctor. For nearly all of my patients I can choose high quality, safe, effective medications off the $4 Walmart/Kroger generic list. There is simply no justification for the Part D program, the cost of which will soon dwarf the cost of Social Security. (A recent study proved that seniors are less likely to buy perfectly good generics because of Part D. The taxpayer gets to eat the wasted money. Those Big Pharma lobbyists sure did earn their paychecks!)