Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

BLOG: Another point of view

In my last blog, “Backdoor health care reform,” some of my readers thought I might have revealed a political bias. I like to keep politics and health care separate, but there are occasions where the two subjects end up on a collision course.

In fairness, I have turned to one of my good friends who may have more right-wing bias in his writings on health care issues.

I introduce Dr. Charles Mund to voice his thoughts on the subject. I will share my thoughts on his piece in the comment section of this post. I invite you to weigh in, as well, and perhaps we can generate a healthy discussion:

Charles R. Mund

Charles R. Mund, OD: The insinuation of de minimis, or “backdoor,” health care reform (ie, the reduction of the individual mandate penalty to zero) into the Trump tax reform bill was not the plenary remedy that is needed to address the aliments that plague the American health care system. But neither was the Affordable Care Act, which turned out to be patently unaffordable for millions.

Of course, the Republicans will tell us that Rome wasn’t built in a day and that the 2018 elections will emancipate them from the John McCain “veto” that forced their backdoor approach. Likewise, when the microphones are off, the Democrats will confess that Obamacare was merely a “transitional form” designed to deconstruct the private health care market in order to ultimately supplant it with a socialistic single-payer system.

This begs the larger ideological question: What kind of health care reform will serve us best? A top-down, one-size-fits-all, command-and-control model under the aegis of the same government that administers the VA? Or a bottom-up, market-based model that encourages and empowers patients to become informed health care consumers, a model overseen by a minimally intrusive amount of government regulation, but with a safety net for those who for one reason or another have difficulty accessing the care they need — including the 13 million who will putatively lose their care by 2027?

The significant problems with the socialized Canadian (Fraser Institute) and UK (Bandler) systems and the malpractice recently unearthed at the VA argue that the latter is the better choice. A free market-based health care system, properly constructed, can offer better and accessible care and at a more affordable cost if the right incentives are in place.