Replace government healthcare with patient-controlled health care
Authors: Waldman Deane 
Published: April 2024

The purpose of the article is to analyse the shortcomings of the state-run healthcare systems and to substantiate the need for and feasibility of transition to a patient-controlled model. It is shown that patient-controlled health care, free from centralised domination, can provide timely, high-quality, compassionate medical care at an affordable price for both individuals and the nation. It significantly expands the patient’s rights and opportunities to choose a doctor according to their own preferences and financial capabilities. The patient pays for the medical service provided directly to the doctor, who no longer has restrictions on choice of treatment protocols or prescription of medicines. The analysis in the article is based mainly on the example of the United States, where federal control for residents is both direct (194 million Americans are covered by Medicaid, Medicare, Tricare or EMTALA) and indirect (138 Americans have private insurance). In addition, aspects of the article analysis also apply to single-payer countries (Canada, the United Kingdom, France and Spain). The article examines the shortcomings of the current US model of its healthcare system in terms of its compliance with the Constitution. It is noted that, according to the Tenth Amendment to the US Constitution, healthcare powers are not among the 18 powers delegated to the federal government. Also, non-compliance with the law is also observed: government control or administration of state Medicaid programmes is contrary to US law; medical autonomy as the patient’s ability to make personal medical decisions without undue influence from the state. Another disadvantage of state-run healthcare system is that state-controlled healthcare payment structure violates the fiduciary relationship between doctor and patient, as doctors’ authority to make medical decisions is limited. It also calls into question the observance in the United States of the citizen’s “right” to receive medical care in its interpretation as a personal service of a professional caregiver when a patient can demand the desired care and the service provider cannot refuse. The article emphasises that state-run healthcare systems create a conflict between efficient use of financial resources and effective provision of medical care. This issue is considered through the prism of the interests of the main stakeholders: shareholders of companies operating in this area, politicians, patients, healthcare providers and administrators. As evidence of the inefficiency of the existing US healthcare system in comparison with other countries, comparative data for different countries on life expectancy and incidence rates of a number of diseases are provided. The author also discusses the problem of limiting access to medical care (rationing) for patients with public health insurance due to a shortage of healthcare professionals accepting new Medicaid patients. This is caused by low reimbursement rates, overly bureaucratic verification procedures for obtaining payment, overregulation of requirements for doctor-patient relations and procedures for reviewing medical errors, the need to comply with population-based clinical algorithms, etc. It leads to a decrease in the quality of medical care, an increase in patient deaths while waiting for medical care, the risk of disease complications due to delays in diagnosis and timely treatment, ignoring the needs of unique, individual patients, and an increase in the likelihood of medical errors. All of the above disadvantages of state-run healthcare are obviated when the patient is in charge, patient-controlled health care.