Proposal to Fix America's Health Care System

University Degree Business and Administrative studies

A Proposal to Fix
America’s Health Care System

For years, U.S. health care has bred a culture of inefficiency and ineffectiveness. Ask any American – doctor, patient, or insurer – about the current system, and they'll no doubt run through a long list of complaints. The US ranks 37th in overall performance in a World Health Organization examination of the world's health care systems (7). The doctors and medical technology that go into American medicine are most certainly the best in the world, but the care that is provided to the American consumer is full of incompetence, enough bureaucracy to make anyone’s head spin, and so many mistakes that medical error is the third-leading cause of death in the US, behind heart disease and cancer. (2) Comprehensive national health care reform is coming. The only questions are “When?” and “What will it look like?” There will be many reform proposals put forward during this process. The key to a true, victorious reformation will be the combination of the best attributes of each proposal and the successful implementation of the resulting plan.

This proposal suggests a one-payer system that promotes wellness and prevention. One-payer systems flourish in many developed countries. In fact, according to the Institute of Medicine of the National Academy of Sciences, the United States is the only wealthy, industrialized nation that does not guarantee universal coverage, and because of this, 18,000 people in the United States die every year from a lack of health insurance--that's two people every hour (4). We have the most expensive system in the world per capita, but we lag behind many developed countries on virtually every health statistic you can name. Single-payer health systems provide everyone with health insurance. They provide universal coverage and have been shown to achieve better health outcomes at lower per capita costs with greater levels of satisfaction among providers and consumers. (6) The government controls the cost of health care and the profit motive is removed, which means the same money can be spread over more people, which saves even more money as well as lives. (3) Patients have access to all medically necessary care, such as doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental care. And patients have their choice of doctors, cheaper prescription drugs, and limited, if any, bills for health care. (7)

“Health care coverage should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient centered, and equitable” (4). This proposal first calls for careful investigation and analysis to eliminate waste and do away with inflationary charges, such as high administrative salaries, unnecessary costs in screening and approving services by non-medically trained personnel, reducing duplicate testing (2), eliminating the purchase of expensive equipment when the similar or same equipment is available and being used under capacity, and by reducing and eliminating the need for using the emergency room for nonemergency needs by having primary care centers available for the entire population. Under the current system, uninsured people are more likely to require expensive, critical care in emergency rooms or hospitals for conditions that would have been responsive to earlier, more appropriate ambulatory care if it had been available to them (4).

Under this proposed single-payer system, doctors would be able to do away with the mounds of paperwork and they could go home with fewer headaches, while at the same time they would be given more freedom and options. Because there would be one form for doctors to fill out regardless of the patient, they wouldn’t have to spend time figuring out a patient's insurance status. The doctors simply bill the payer electronically for the treatment or care they provide, and in the majority of cases, within 30 days, the doctors are paid. They would have more time dedicated to actually helping ...

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The disparity between specialist physicians’ and primary care physicians’ salaries would be reduced. The incomes of primary care physicians would stay about the same. Specialists' incomes, however, would decrease. This decrease in earnings would be offset by the reduction in costs that would be realized: doctors could save the salaries of office staff and clerical employees that file the countless forms and fight whimsical denials, in addition to the health insurance premiums that they will no longer have to pay for all other workers. Doctors would most likely see decreases in malpractice insurance premiums as well. Laws will be written to limit the dollar amount of malpractice suits because future medical costs need not be a part of a lawsuit. All future costs will be covered. Moreover, most patients would not be as likely to sue since they know they would have health insurance to cover expenses if some problem were to arise later. This plan can also help to eliminate defensive medicine where needless procedures are performed to protect the provider against possible lawsuits. (8)

Hospitals would all be non-profit. Investors would be bought out, and hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the single payer to cover its day-to-day expenses. A separate source of funds would cover development expenses such as hospital expansion, the purchase of health care technology, and marketing. Hospitals would no longer be forced to close because of unpaid bills.

To be affordable, contributions toward health insurance premiums should permit individuals and families to pay for the other basic necessities of life, such as rent and food, and to pay any deductibles or co-payments required when using health services. Bankruptcy due to health care will become a thing of the past under his proposal. Both employers and employees will have a tax liability. Health care coverage is already heavily subsidized by federal, state, and local taxes. (4) Under the single-payer plan, employers would pay a small payroll tax, but this tax would be in lieu of the health care premiums that most employers pay now. Nearly every employer that currently offers health insurance would actually save money. Small businesses would no longer be at a disadvantage in providing adequate health coverage for their employees and would be better able to compete for the best candidates.

Technology can help doctors and hospitals invent new ways to care for patients that are safer, more effective, and cheaper. This proposal provides for an integrated Health Information Technology system that can improve quality of care and help to control costs. An integrated Health Information Technology system will be a great improvement over the current fragmented system. Technology can be used to better manage chronic diseases. With new software and better databases, chronic disease patients can be easily identified and placed into early-intervention programs, with computer-generated reminders to both doctors and patients to take preventive steps. Having a regular provider of care, particularly for primary care and chronic conditions, is considered a predictor of quality. (2) With the right safeguards built into it, this system could also offer important data for future planning purposes.

Universal health insurance is the key to obtaining needed health care services, and those who lack insurance are less likely to get timely and appropriate care than their insured counterparts. Evidence from the scientific literature overwhelmingly shows that those without insurance — children as well as adults — suffer worse health and die sooner than those who have coverage. (4) As part of promoting wellness, a team of health educators will be a mandated part of each community. These individuals will be trained to provide the following services:

community capacity building in which the local population they serve is taught how to identify their own needs and concerns and how to plan to meet these needs and concerns
para-professional training in which local populations who desire to help themselves learn relevant health information that empowers them to do so
any special health education programs desired and identified as needed by the community, (e.g. lifestyle issues associated with preventing or treating diabetes, heart disease, cancer, parenting training)
provisions for alternative and complementary medicine desired by that community. (8)

The US would have six regional payers -- Western, Mountain, South, Midwest, South, and Northeast. Each regional payer would be responsible for a certain number of states, and they would work collectively, so that if a person were to take a cross-country trip, he or she would still be covered according to reasonable guidelines that require charges not exceed a certain percentage of cost above Medicare. COBRA guidelines would be followed for those permanently moving from their home state. (8) These regional payers would handle their states' paperwork and payments, and would get their funds from the federal government, who would collect all the money. This program will be governed by federal, state, regional and local panels of providers and consumers. The federal board will oversee both state and regional boards. The regional and state boards will have primary responsibility for regional and state planning in such areas of technology, access to care, group purchases of medications, and information sharing. (8)

Within each of the state boards, local boards will be formed for the local population. These boards will consist of three elected providers, three consumers and one healthcare expert that is elected or appointed by the other six board members. These local boards will focus on governance issues of a local nature, such as where to put wellness resources, how to better staff underserved areas, evaluating local need, and the training of new providers in their area. In determining the priority and limitations on funding, local boards will make recommendations to regional boards. It is assumed these priorities will reflect the needs of local communities because elected leaders to governing boards are answerable to their communities. (8)

All US Citizens could potentially benefit from this proposal because it will:

guarantee universal coverage
eliminate pre-existing conditions as a consideration
eliminate administrative wastes in time and costs for providers and consumers
eliminate the fear of losing or changing job because of lost of health care coverage
control price increases for individuals and businesses
add important upstream services in prevention, protection and promotion that can prevent or lessen the consequences of illnesses
give power to providers and consumers, thereby enhancing working conditions for providers and quality of care for consumers

This proposal will expand healthcare access for all citizens by providing comprehensive universal coverage for the under-insured and uninsured and reversing the trends of the rising number of uninsured. The economic value to be gained in terms of better health outcomes once those now uninsured become insured would likely exceed the additional costs of providing them with same level of services used by those with public or private coverage (4). This proposal will also expand coverage for many people that are already insured by removing high deductibles to encourage early intervention. It will provide services that may often be excluded, such as mental health or substance abuse and provide comprehensive access to wellness programs, including health promotion, prevention and protection. By providing governance access to the whole system, the consumer and the provider will be empowered to have more of a voice in their care.

The U.S. health care system is the subject of much polarizing debate. At one extreme are those who argue that Americans have the “best health care system in the world”, pointing to the freely available medical technology and state-of-the-art facilities that have become so highly symbolic of the system. At the other extreme are those who berate the American system as being fragmented and inefficient, pointing to the fact that America spends more on health care than any other country in the world yet still suffers from massive uninsurance, uneven quality, and administrative waste. The goals of this proposal are to achieve universal health coverage, improve access and quality of health care, and contain costs while preserving roles for government, employers, providers and individuals/families. This plan is a simple, fair, accountable, and affordable system to fund necessary health care for all citizens of the United States.

References

Bodenheimer, Thomas, M.D., Goroll, Allan H., M.D., Lee, Thomas H., M.D., Starfield, Barbara, M.D., M.P.H., and Treadway, Katharine, M.D. (2008, November). Redesigning Primary Care. Retrieved November 28, 2008, from
Businessweek. (2005, October 31). This Man Wants To Heal Health Care. Retrieved November 29, 2008, from
Cihak, Robert J., MD, and Matthews, Merrill, Jr., PhD. Health Care Quality: Would It Survive a Single-Payer System? (n.d.). Retrieved November 25, 2008, from
Insuring America's Health: Principles and Recommendations. (n.d.) Retrieved December 5, 2008, from
Saib, Daina (Fall 2008). Doctor's Orders: Health Coverage for Everyone. Retrieved November 12, 2008, from
Sultz, Harry A. and Young, Kristina M. (2009). Health Care USA: Understanding Its Organization and Delivery. Sudbury, MA; Jones and Bartlett Publishers.
Wikipedia. (n.d.). Health Care in the Unites States. Retrieved December 5, 2008, from
Zisman, Stuart, Dr.P.H. Universal Capitation Plan. Retrieved November 25, 2008, from

Proposal to Fix America's Health Care System

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