In 1996, Dr. Ben Carson, now a conservative favorite and potential presidential candidate, wrote a paper outlining his vision for U.S. health care.
Some of his proposals: nationalized catastrophic care, essentially replacing Medicaid with health care food stamps, and "national guidelines" about when the elderly and terminally ill should receive care.
By implementing government-run catastrophic health care, Carson argued, the price of premiums would go down so much that employer-based health care would come to an end and people would own their own health care policies. In fact, Carson wrote, Medicare would also no longer be necessary.
In recent years, Carson has been a vociferous critic of the Affordable Care Act. His current-day proposals for health care involve giving a $2,000 stipend to each American to set up Health Savings Accounts — and little else from the government, he told Politico last year.
Nearly two decades ago, though, in the essay published by the Harvard Journal of Minority Public Health, Carson uses the food-stamp program and some disaster relief programs as models for improving U.S. health care and, in some cases, the means for dramatically reducing its costs.
Carson writes of using computers to improve national records, making the track record of physicians accessible and transparent, and requiring insurers to provide coverage despite pre-existing conditions. But the centerpiece of Carson's plan is government-run health care for catastrophic events.
"It has been generally been assumed that we wish to avoid a single-payer health care system," wrote Carson. "Yet there are some well-defined programs that the federal government has handled reasonably well, such as the Disaster Relief Program."
Carson describes how catastrophic health care events account for the biggest costs to insurers — and therefore, the reason for skyrocketing premiums as medical advances in the second half of the 20th century allowed Americans to live much longer. He cites the "massive aid" the government provides to citizens after disasters as a strong model.
"The next question is, who will pay for catastrophic care? The answer: the government-run catastrophic health-fund. Such a fund would be supported by a mandatory contribution of approximately 10 to 15 percent of profits of each health insurance company, including managed care operations."
The essay also features a particularly sharp passage about how Americans view health care for the elderly and very ill.
"Unlike many other advanced nations," Carson wrote, "American society has not yet come to terms with the fact that it is not unreasonable to keep simply someone comfortable at home when catastrophic illness occurs rather than putting them in an intensive care unit, poking and prodding them, operating and testing them ad nauseam, why not allow them the dignity of dying in comfort, at home, with an attendant if necessary?"
One solution, Carson wrote, would be to establish "national guidelines" for care, noting at one point in the essay that if the government provided for catastrophic care, it "would facilitate a national debate on what catastrophic conditions should be treated and to what extent."
"Decisions on who should be treated and who should not be treated clearly requires some national guidelines and obviously should be made based on the viability of the patient rather than the age of the patient," he wrote. "There are clearly many 90-year-old individuals who are healthier than some 40 or 50-year-old individuals and certainly medical treatment should not be withheld if there is a reasonable chance of recovery and resumption of a normal lifestyle."
These national guidelines are not the only federal standards for care that Carson proposes.
Earlier in the essay, Carson proposes as a malpractice reform, that "a law could simply be passed stating that a physician who is adhering to the national guidelines for the treatment of a certain diagnosis could not be sued even if the results of the treatment were not optimal."
To take care of the very poor, Carson proposed a system of "health stamps" explicitly modeled after the food-stamp program.
"Instead of giving medical assistance cards to the poor, they could be issued the equivalent of health stamps," he wrote. "These would be credit vouchers (which could be in the form of electronic money) that could be used to purchase medical services in the same way that food stamps are used to purchase food items."
Carson's current rhetoric and proposals stand in sharp contrast to those outlined in his article.
Last year, he told Politico that in his current proposal for health care reform, "[t]he only responsibility of the government would be providing $2,000 per year for every American citizen ... to provide everyone with a health savings account" — a role that falls far short of his earlier suggestion that the government take over catastrophic coverage from private insurers.
In the same interview, he also criticized government-assistance programs.
"We take the downtrodden in our society and we pat them on the head," Carson said to Politico. "We say 'There, there, you poor little thing. I'm gonna give you free health care. I'm gonna give you housing. I'm gonna give you food stamps. You don't have to worry about anything."
In a statement to BuzzFeed News, Terry Giles, a Carson confidant who will chair his campaign if he runs, said the essay was evidence that Carson is a deep-thinker about U.S. health care — and that the positions were from long ago.
"The Harvard Journal article from two decades ago is proof that Dr. Carson has for a very long time been thinking about how health care could be delivered to all Americans. This is not an issue he has only recently thought about but a plan that has matured and been more perfected by him over many years. His beginning view 19 years ago on health care for all Americans is as relevant to his view today, as our current military action in Afghanistan is compared to our military strategy in Afghanistan two decades ago."
On the government-run catastrophic care fund:
Carson suggests that such a program would result in "a significant reduction in health insurance premiums," since companies would be able to "reap very substantial profits" while charging consumers a lower rate if freed from the responsibility of providing insurance for catastrophic care — a situation which would also allow the government to crack down on "profiteering," and establish a reasonable regulatory environment:
For example, if a company collected $5 billion in premiums, paid out $1 billion in claims, and had predetermined and pre-approved business expenses of $1 billion, that would result in a profit of $3 billion. This amount would be excessive since they could not claim to be saving for future catastrophic health care events since the government would be taking care of such situations. The health insurance companies would have to return the money to clients or drastically reduce further premiums to comply with a pre-established profit limit.
Other insurance regulations would also need to occur, such as not permitting insurance companies to exclude those with pre-existing conditions, not allowing them to effectively exclude people by raising their premiums to prohibitive levels, etc. It should, however, be kept in mind that since the companies would not be required to cover catastrophic disease, there would be little reason for them to engage in these unfair activities.
The resultant savings, Carson writes later in the essay, would make it possible for people to own their policies — thus getting rid of the need for Medicare, because people's insurance would not be tied to their employment, and therefore would not be affected by retirement.
Medicare has not been addressed in this proposal because it would not be necessary with this system. Since individuals would own and maintain their own health care policies, retirement from the work force would not affect them, just as retirement does not affect homeowners' policies or automobile insurance policies. Certainly some mechanism for lowering premiums for retired people with fixed incomes should be explored.
On national guidelines and care for the very sick:
Another area in need of reform is a very touchy issue that involves care for terminal patients or for the patient who has a very short life expectancy. As our knowledge increases and our technical abilities advance, we find ourselves capable of doing such procedures as a quadruple bypass on 85-year-old individuals or extensive resections of malignancies in very elderly individuals who also have other medical problems. As our general population continues to age and as our technical abilities continue to improve we will find ourselves in a position of being able to keep most people alive, although perhaps at not a very active level, well beyond their 100th birthday. The question is: Should we do it simply because we can? It is well known that up to half of the medical expenses incurred in the average American's life are incurred during the last six months of life. The reason for this is that unlike many other advanced nations, American society has not yet come to terms with the fact that it is not unreasonable to keep simply someone comfortable at home when catastrophic illness occurs rather than putting them in an intensive care unit, poking and prodding them, operating and testing them ad nauseam, why not allow them the dignity of dying in comfort, at home, with an attendant if necessary?
Decisions on who should be treated and who should not be treated clearly requires some national guidelines and obviously should be made based on the viability of the patient rather than the age of the patient. There are clearly many 90-year-old individuals who are healthier than some 40 or 50-year-old individuals and certainly medical treatment should not be withheld if there is a reasonable chance of recovery and resumption of a normal lifestyle. If a patient insisted on having everything done, consideration of more aggressive treatment should be given. This author believes that most reasonable terminally ill patients would rather die in comfort and dignity than be tormented until the end in a hospital setting.
On care for the poor:
The final area to be covered in this particular discussion concerns health care for the indigent or those individuals who require medical assistance. Again, it might be wise to look at a federal program that could serve as a model. This program is the Food Stamp Program. Instead of giving medical assistance cards to the poor, they could be issued the equivalent of health stamps. These would be credit vouchers (which could be in the form of electronic money) that could be used to purchase medical services in the same way that food stamps are used to purchase food items. These health stamps could be allocated according to pre-established criteria on a monthly basis. If a person receiving such aid frequented emergency rooms, for example, for their primary care needs, their allocation of health vouchers would obviously be depleted quickly and that would carry significant consequences. On the other hand, if they used those same vouchers at a primary care clinic they would stretch much further. This would also encourage individuals to establish relationships with physicians which, in turn would facilitate preventative care measures.
A copy of the full article is below:
Megan Apper contributed reporting.