Six Steps for Trump to Turbocharge Patient Freedom


By Elizabeth Lee Vliet, M.D. –

Free markets in medicine are not “broken;” they have not been allowed to work since 1944 when wartime federal policies began disturbing market forces. Federal control of prices and service delivery further expanded following the Medicare Act of 1965. In 2010, Obamacare crushed medical insurance plans, doctors, hospitals, pharmaceutical companies, medical device makers and home health agencies under an avalanche of expanded government control. Costs exploded. Patients suffered with fewer options for doctors, hospitals and access to treatment.

President Trump now seeks ways to unleash patient choices by eliminating many Obama-era rules and regulations that drive up costs and limit medical freedom.

Step One: Trump is urging the Department of Labor expand the use of Association Health Plans (AHPs). AHPs allow Americans of shared interests and connections to join groups that form health insurance plans they control. AHPs offer three major advantages: potentially huge cost savings, escape from state-based required coverages, and employees more easily able to keep current health plans if they change jobs. AHPs are estimated to cost about $9,700 per year less by 2022 than the individual market.

Step Two: Trump proposes that the Department of Health and Human Services (HHS) expand access to Short Term Health Plans and allow guaranteed renewability. Under President Obama, these plans were limited to 90 days of coverage and could not be renewed. Secretary Azar is expected to extend the Short Term Plan limit to 364 days. Coverage is estimated to cost on average $342 a month, vs. $619 per month for an Obamacare Exchange plan. If consumers are allowed to retain renewable plans long term, these plans would resemble what medical insurance used to be, and patients with expensive illnesses would not be forced back on the higher cost Obamacare Exchanges.

Step Three: Turbo-charge free market changes by allowing patients to use their Health Savings Account funds for direct payment to physicians who offer “direct-pay” practices free of insurance controls. Such practices may be called Direct Primary Care (DPC), Concierge Medicine, or simply “Fee-For-Service.” Before the 1980s when managed care came to dominate, patients paid doctors directly. Costs were lower, and insurance company bureaucrats did not have to “approve” treatment. Some direct pay practices also offer medications at far lower costs than available on Medicare Rx plans. Direct-pay options are sweeping the country as patients yearn for more quality time with their doctors at an affordable price.

Direct Pay advantages should be obvious, but shockingly, the Internal Revenue Service under President Obama blocked the use of DPC for the 30 million Americans with HSAs. John Koskinen, the same IRS commissioner who stonewalled efforts by Congress to investigate Lois Lerner’s IRS retaliation against conservatives, issued a letter prohibiting patients from contributing to their HSA if they are in a Direct Pay practice. Further restricting consumers’ freedom, Koskinen’s letter prohibited HSA funds from being used for Direct Pay practices.

This flawed IRS decree, not legislation, is yet another example of Obama-era Democrats trapping patients in government regulations restricting patients’ freedom to choose lower cost medical care. Senators Ted Cruz and Ron Johnson wrote Treasury asking for a reversal.  In addition 1,125 patients and doctors have asked Congress to pass the Primary Care Enhancement Act (HR 365/S 1358) and force the IRS to change its misguided interpretation of law.

Step four: President Trump promised to lower prescription drug costs and allow patients to purchase medications overseas, if similar quality and safety guidelines are in place. At present, the FDA appears to be sabotaging this promise by blocking several reliable Canadian and UK pharmacies from selling to Americans lower cost FDA-approved medications for which patients in the US pay exorbitant prices under “insurance plans.”  One example is EstroGel (bioidential estradiol), developed and approved in Europe in 1974, which remains the most popular and lowest cost form of hormone replacement for women across Europe and Canada. EstroGel was not approved by the US FDA until 2004, 30 years later, and for about ten times the European cost.

Step five: Eliminate the “safe harbor” that protects pharmacy benefits managers (PBMs) from risking prosecution under the Anti-Kickback Statute. These companies, such as Cover My Meds and others, are paid to restrict physicians from prescribing many medications for patients unless they first do a burdensome “Prior Authorization.” PBMs interfere with patient care, add delays, and drive up costs with layers of costly bureaucrats. PBMs often make more profit from a drug than the manufacturer does.

Step Six: President Trump should expand Health Savings Accounts three ways: 1) Allow contributions past age 65 since many people are healthy enough to work to age 70 or 75 and beyond. 2) Raise the maximum limit on amounts patients may contribute to the HSA they own. 3) Expand the healthcare services allowed to be purchased with HSA dollars that Obama-era Democrats restricted.

Congress has broken its promise to repeal Obamacare. President Trump can keep his promises to free Americans from Obamacare’s disastrous costs and restrictions on medical freedom by either directing HHS to take these steps now, or by an Executive Order authorizing these changes. Patients and the health of the medical delivery system would be the winners.  The only losers would be CEOs, bureaucrats, and crony capitalist middlemen enriching themselves at the expense of patients and those who care for them.

Author/Contributor short bio:

  • Vliet has been a leader in patient centered, individualized medical care. Since 1986, she has practiced medicine independent of insurance contracts that interfere with patient-physician relationships and decision-making. Dr. Vliet focus is medical freedom and free market approaches to healthcare. Dr. Vliet is the founder of Vive Life Center and Hormone Health Strategies with medical practices in Tucson AZ and Dallas TX, specializing in preventive and climacteric medicine with an integrated approach to evaluation and treatment of women and men with complex medical and hormonal problems from puberty to late life.
  • Vliet is a 2014 Ellis Island Medal of Honor recipient for her national and international educational efforts in health, wellness, and endocrine aging in men and women, and is recognized in the US as a motivational speaker in health and wellness and a powerful patient advocate, proponent of free market approaches to lower healthcare costs.  Dr. Vliet is the recipient of Voice of Women Award from Arizona Foundation for Women in recognition of her pioneering advocacy for the overlooked hormone connections in women’s health.
  • Vliet’s consumer health books include: It’s My Ovaries, Stupid; Screaming To Be Heard: Hormonal Connections Women Suspect– And Doctors STILL  Ignore; Women, Weight and Hormones; The Savvy Woman’s Guide to PCOS,  The Savvy Woman’s Guide to Great Sex, Strength, and Stamina.
  • Vliet is a past Director of the Association of American Physicians and Surgeons (AAPS), a member of the AAPS Editorial Writing Team on healthcare reform, and a member of International Menopause Society and the International Society for The Study of the Aging Male (ISSAM). She received her M.D. degree and internship in Internal Medicine at Eastern Virginia Medical School, and completed specialty training at Johns Hopkins Hospital.  She earned her B.S. and Master’s degrees from the College of William and Mary in Virginia.
  • Vliet has appeared on FOX NEWS, Cavuto, Stuart Varney Show, Fox and Friends, Sean Hannity and many nationally syndicated radio shows across the country as well as presented hundreds of Healthcare Town Halls addressing the economic and medical impact of the 2010 healthcare law and free market reforms, as well as seminars and radio shows on healthcare reform, Men’s Health and Women’s Health.
  • Vliet speaks as an independent physician, not as an official spokesperson for any organization or political party. Dr. Vliet has no financial ties to any health care system or health insurance plan.  Her allegiance and advocacy is to and for patients.