You likely have not heard of Dr. Alieta Eck. Don’t feel bad. She’s not the kind to seek the spotlight. Dr. Eck is a gentle soul, soft spoken, humble, and unassuming. She also has a great heart for charity, and this was undoubtedly the impetus behind her choice to study medicine in the first place, and later to found the Zarephath Health Center (ZHC), a free medical clinic which has provided quality healthcare for the poor and uninsured for over a decade. The ZHC operates out of a 5,000 square foot building (an old schoolhouse that was not being used), the inside of which has been converted into five exam rooms, three intake rooms, and a classroom. It is open four days per week, and is staffed entirely by volunteers.
There is a lot wrong with America today. People like Dr. Eck are what is right.
Incidentally, Dr. Eck is also a Republican candidate for Congress in New Jersey. Her campaign has not received much attention even in her own state, and almost none nationally. And it might never, as her district has been gerrymandered into a Democrat stronghold and the pundit class has already decided that it cannot be won by a Republican. In New Jersey, being a Republican is rarely an advantage. But while Dr. Eck’s choice of party affiliation might not have made the most sense politically, it was nevertheless the appropriate choice considering her record of high achievement, entrepreneurship, and compassion for the poor.
Besides, Alieta Eck is not a natural politician, and that’s welcome. She actually has expertise and ideas, and the most notable of these is the centerpiece of her campaign: a plan to replace the much-derided Obamacare with a much more affordable, and decidedly less bureaucratic healthcare model based on her work at the ZHC.
Let’s call it “AlietaCare.”
Dr. Eck founded the ZHC in 2003 in response to government insurance mandates (Obamacare provides thousands of new pages of these mandates) causing health insurance premiums to spiral out of control, leaving an increasing number of the poor without insurance. But according to Dr. Eck, “the poor don’t really need insurance. You need insurance if you have to protect your assets. What they need is medical care, when they need medical care. And they need to know there’s a place they can go when they get sick and they have no money to take care of themselves.”
The problem is that too often such a place is a hospital emergency room, each visit to which, on average, costs taxpayers roughly $1,000. This is especially troublesome because Medicaid rolls are expected to double under Obamacare, and Medicaid patients are substantially more likely to seek non-emergent care at an emergency room than non-Medicaid enrollees. But the ZHC costs only $13 per visit, and all of that is covered by private donations.
Of course, any sort of healthcare plan has to have a sufficient number of physicians to care for all the patients in the system. But physicians are increasingly refusing to accept Medicaid due to its cost restrictions, and there seems to be an acceleration in physicians closing their offices altogether and/or retiring early as their diminishing profits fail to keep up with escalating costs, in particular the increasingly prohibitive cost of malpractice insurance. While an attorney or accountant might pay $2,000 per year for professional malpractice insurance, a doctor in internal medicine can expect to pay $20,000. Obstetricians and gynecologists can pay anywhere from $85,000 to $200,000 annually.
“We have a system that is pretty hostile to the medical community,” says Dr. Eck, “and doctors are simply picking up and leaving.”
AlietaCare promises to reverse this trend. Under Eck’s plan, physicians, dentists, and other medical professionals who would donate four hours per week in a free, non-government, would receive free malpractice coverage from their home state, which would bear all the costs of litigating malpractice claims, and paying the judgments. The participating physicians would also be protected for liability purposes under the Federal Tort Claims Act (FTCA), which disallows punitive damages. As it is, the FTCA already covers doctors for work they do in free clinics, but this would expand that coverage to their private practices as well.
While it may sound prohibitively expensive for a state to bear such a cost, Dr. Eck notes that all of New Jersey’s doctors combined pay $300 million in malpractice insurance premiums per year, and that money covers all litigation expenses, all settlements and judgments against participating doctors, and leaves enough left over to run profitable insurance companies. To put that in perspective, such a cost would comprise less than 1% of New Jersey’s $34 billion budget, and would be 90% cheaper than the $3 billion spent in New Jersey every year on Medicaid, to say nothing of the other $1 billion spent on charity care. And that’s if every single doctor chose to participate, which would seem unlikely.
In speaking with Dr. Eck, I articulated two concerns about her plan. First, everyone likes to talk about limiting damages in lawsuits, until they’re a victim and need to file a lawsuit. Lawyers often have to turn away severely injured clients because the law does not allow for a sufficient recovery, or due to a legal immunity that insulated a wrongdoer from liability. This occurs frequently with ERISA-based health insurance plans, which are able to control costs in large part by making it nearly impossible to sue the insurance provider for damaging a client by wrongly denying coverage for treatment. Similarly, New Jersey was able to get its automobile insurance premiums under control a few years ago by limiting lawsuits to those instances where a permanent, or other severe injury (such as death of a fetus) occurred.[1] And everyone loves those lower monthly rates, until they’re in a car accident and can’t recover for their pain and suffering because their crippling back injury only consists of disc bulges instead of herniations, or they have only soft tissue damage and deep cuts and bruises after flying through the windshield and waking up in a ditch.
AlietaCare presents the same paradox. By placing doctors under the protection of the Federal Tort Claims Act and eliminating punitive damages, it is going to be increasingly difficult to find plaintiff’s attorneys to litigate a medical malpractice case, since those attorneys often rely on large punitive damage awards to offset the tens, if not hundreds of thousands of dollars it costs them out of pocket to hire the experts needed to litigate these things (not including the cost of their time), with no guarantee of a result. And keep in mind, this protection would extend not just to the four hours per week that the doctor would be donating to a clinic, but to his paying patients in his regular practice as well, who are not receiving the benefit of free medical care.
Dr. Eck responded to this concern by proposing that patients be allowed to buy “event insurance” before going in for treatment, similar to the event insurance people sometimes buy on flights in order to reimburse themselves for fees and costs (such as an overnight hotel stay, meals, transportation, etc.) necessitated by a last minute trip delay or trip cancellation. But this places the cost and burden on the consumer, rather than on the provider whose job it is supposed to be to provide quality care in the first place.
Perhaps the better idea would simply be to have the state pay for the insurance premiums through the already existing private insurance companies, instead of through a government apparatus. That way the insurance companies would still be able to police their insured doctors, clients would be able to recover their due compensation when injured, and we can avoid creating yet another enormous government bureaucracy.
The second concern I articulated was that AlietaCare seemed to rely very heavily on volunteers. It’s one thing to pay for the insurance premiums for doctors, but what about the rest of the staffers? Dr. Eck prefers to use unpaid volunteers because of the purity of their motives, but I fear there would be a scarcity of workers. Instead, it might make more sense to use people collecting government benefits to help staff the facilities. If people are on government assistance because they can’t find work, then give them work! As it is we’re already paying them not to work, so there’s no additional cost.
But these are a minor details. Any healthcare plan is going to require tradeoffs, and there is too much right about AlietaCare to dwell on minutiae. What’s important is that the framework of AlietaCare is solid: free labor from doctors in exchange for malpractice insurance that only costs the state fraction of what it’s presently paying to care for the poor. And it doesn’t interfere with the health insurance market, meaning that not only will AlietaCare reduce premiums to pre-Obamacare levels, it will actually make good on Obamacare’s false promise that if you like your insurance you can keep it.
Perhaps best of all, there’s no reason AlietaCare can’t be implemented right now! Unlike Obamacare, we don’t need to pass the bill to see what’s in it, because it’s really not very complicated. Even a lawmaker as lazy as John Conyers (D. MI), who didn’t have time to read the Obamacare bill before voting for it (but manages to find time to read Playboy), should be able to understand the program simply by perusing an essay as short as this one, which, by the way, has significantly fewer words than Obamacare has pages.
And when people do learn about AlietaCare, they’ll see that it does not involve a massive redistribution of wealth, it greatly reduces the role and cost of government, it gets us off this inexorable death spiral toward to a single payer monopoly, and it helps the poor.
For all those reasons, America will love it, and Democrats will oppose it to the bitter end.
[1] Technically, participation in this program is optional, but the cost savings to the average New Jersey driver are so great that almost all insured drivers choose the lower premium with the higher injury threshold.
