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Analysis

Neurosurgeon Focuses Congressional Campaign on Including Patients in Cost Conversations

By Jack O'Brien  
   October 11, 2018

Dr. Jim Maxwell, who has served as chief of neurosurgery at Rochester General Hospital since 1998, is campaigning to represent New York's 25th congressional district.

After performing thousands of surgeries and being entrenched in healthcare leadership for over three decades as a neurosurgeon, Dr. Jim Maxwell wants to take his medical talents to Washington, D.C. by representing New York's 25th congressional district.

Maxwell told HealthLeaders that his career as a doctor, including his 20 years as chief of neurosurgery at Rochester General Hospital, has centered around the simple premise of helping people, and is one of the many healthcare-related factors driving his campaign for public office.

Running as a Republican physician, Maxwell discussed the merits of repealing-and-replacing the Affordable Care Act (ACA), how to fix the healthcare system, and the weaknesses of the Medicare for All proposal from some Democrats.

The following transcript has been lightly edited.

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HL: On your campaign's website, you refer to the healthcare system as "broken." In your opinion, what is broken about the healthcare system, and how can it be fixed?

Maxwell: I think especially in Rochester, I'm proud to say healthcare is [of] good quality. I think people in Monroe County receive good healthcare, our doctors are high quality, and we have enough specialists.

The broken part has to do with the economics in a simple sense [that] healthcare in the United States is too expensive. What I have heard and listened to over the last decade has been the great attention to coverage: "We need more people covered, but how good is the coverage? How high are the deductibles, and how many copays are there?" It's a bit of a shell game with people trying to shift the burden of paying for the coverage to somebody else. [What] I haven't heard a whole lot [about] is attention to pure cost.

Second, if you do consider cost and you say it's too expensive, how do you lower the cost? I think that's what we need to do to fix this economically broken system that is absolutely unsustainable into the future. [We need] mechanisms to reduce cost.

HL: Does that involve altering the current state of the ACA, and if so, how?

Maxwell: Yes, I think the ACA was an attempt that failed to address costs; it was all about coverage. The fury at the beginning of it was a number of Americans [did] not have healthcare coverage—we've got to get people covered and the expansion of Medicaid helped with that. The vast majority of people who get their health insurance through their employer were unaffected by the ACA, but where the pinch came in [was] for the people who made more than what was allowable for the Medicaid expansion.

People in the middle were forced by law to buy health insurance that had no healthcare cost constraints upon it, and it rose and rose, and yet they were mandated to buy it. That was a nightmare for those people. They were forced to buy something that in some way they didn't need at the moment and they had no way to afford it. That's where I think Obamacare really fell apart. I am a Republican, and I'll say this: I don't think the Republicans had a well-thought out alternative to Obamacare, and so I think right now we're sort of floundering.

HL: What would you like to see Republicans in Congress do to address the ACA as it stands right now?

Maxwell: I would like to see it scrapped. I would like to go back to the drawing board and sort of start all over again. I think it has to be a bipartisan [plan], it can't be the product of one party. It's been a winner-take-all situation when it comes to healthcare and that's not the way to solve the problem. I would have no problem with a bipartisan committee in a two-year time frame to come up with another plan. I think scrapping Obamacare and replacing it with luck is a problem.

HL: Since you're running as a Republican, I imagine that solution would probably not be the Medicare for All proposal that some on the Democratic side have started to embrace?

Maxwell: Yes, I think Medicare for All would be a disaster for a bunch of different reasons. No. 1, I don't think the federal government has the necessary skill set to run the whole healthcare system. They try to run the VA, they try to run the Indian Health Service, and

there are huge problems with both. If you were to dump the whole healthcare system in the lap of federal bureaucrats, I think it would be a disaster.

No. 2, it's not an economically sustainable model. I've read the reports that if Medicare for All came to be, it would more than double the federal budget, and we're struggling under Medicare costs as it is. I think it would just break the bank and break the back of the federal system to have Medicare for All.

But most importantly, I don't envision how Medicare for All would reduce cost. I get that administration costs might be somewhat lower—there's fat in the system and Medicare might be more lean and mean—but there is not an intrinsic mechanism to go after cost through the Medicare system.

HL: What should hospital executives and health system leaders take away from your candidacy?

Maxwell: What I would like to do is put the patient more into the driver's seat of their healthcare costs options. Right now, they are in the back room and they're not included in the conversation about what's best for them.

So as to make healthcare right-sized for each individual patient and family, they [should] be allowed to purchase their own individual policies in the marketplace. Employers would transfer money, as they already do, to pay for their employees' health insurance. Instead of writing a colossal check to any individual insurance company, they would give that same amount of money on an individual basis to the employee.

[Employees] should be mandated and tasked to put it in an HSA and to spend it on a healthcare policy that they choose. They would be able to pick right-size, whether they want a Cadillac plan or a Volkswagen Beetle plan. And to make it fair that insurance policies be competitive across state lines and that they all fit on the same page for comparison's sake, every insurance company [should] put their cost for 10 sessions of physical therapy, or an appendectomy, or cancer treatment on a [webpage] and you can compare apples to apples.

I bet you in that competitive environment, with the insurance companies wanting to woo individual clients that have a big check in their hand, that they will become much more competitive. That's a mechanism for lowering costs.

I would tell the CEOs, CFOs, and the CNOs to get out of the way a bit and let the patient drive the car. The patient would be more satisfied, and I think the whole problem with cost would come down.

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Jack O'Brien is the finance editor at HealthLeaders. 


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