One Doctor - One Patient
Everything in healthcare begins when a doctor and a patient agree upon a medical collaboration. The patient may come from any walk of life in America, including other doctors.
The doctor can only come from one of two regulated sources: federal or state.
Probably 90% of all doctors actively treating patients are in the private practice system regulated by the fifty states and the District of Columbia.
Federal healthcare, through Medicare, Medicaid, the Department of Defense, the Veterans Administration and Public Health, may account for almost one half of all healthcare costs, but those Medicare and Medicaid patients are primarily treated in private practice.
Therefore state legislatures are the principle source of medical practice regulation. And they aren’t up to the task.
The practice of medicine is the least regulated economic activity in America.
Someone, somewhere, hopefully, will test the validity of that statement, which demands to be tested.
The first clue that medical practice truly is the least regulated economic activity is that NO state government can produce one single person who has complete knowledge of:
1. Every existing statute, rule, regulation, and policy governing the practice of medicine in that state.
2. Regulatory mechanisms created by the above listed legislated requirements.
3. Evidence of effective regulatory results.
The second clue will appear when it becomes evident:
1. How many different persons are necessary to obtain the above data.
2. How long it takes to obtain the data.
3. How little regulatory mechanism truly exists.
The regulatory lines were blurred beginning with Medicare in 1965. Prior to that they were faint, if not non-existent in most, if not all the fifty states.
While most states were trying to establish some semblance of medical practice regulation, particularly at the hospital medical staff level, the federal government was establishing their immense presence.
Both houses of Congress have had numerous committees and subcommittees dealing with healthcare issues. The same can be said for the fifty state legislatures. There are also a plethora of governmental and non-governmental agencies, groups, organizations, foundations, etc., “focused” on healthcare issues, yet none of them has ever thought that a clear distinction between federal and state regulatory responsibility was necessary.
No consideration for healthcare change should take place before establishing a clear delineation between federally-controlled healthcare and state-regulated healthcare.
Precipitous Congressional healthcare change would be, “putting the cart before the horse.” Currently both Congress and all state legislatures are all asleep at the switch