Health Care Reform Proposal and Considerations

An open letter on Health Care Reform.

Yes, there is a need.  Much of the discussion on this topic that has been provided via Presidential speeches, town hall discussions and TV commentators and specialists suggests viable changes, cost effective ones too, that would make America’s current superior Health Care system even better, especially more cost efficient and available.    To begin, however, parameters need to be considered and established.

Ffingers crossedirst – The medical Provider network needs to be analyzed from the viewpoint of current capacity to handle patients, from the general practitioner to the specialist to the hospital to the nursing home.  The current patient load and the service received must be compared to the future potential load and loss of services, or strains on the system, and to include the time and incentives needed to build the infrastructure needed to service the forecast increased demand.

Second – Financial resources and needs must be studied.  From the potential for self-sufficiency, the current costs and deficits of the system, a proper look at todays ‘retail’ pricing for services vs. that which is actually paid by government, insurers and other third-party payers.  Come up with a figure reflects the true cost of care in America.  In addition make known the burden of the expense of the current system borne by those now paying for insurance to care for the underinsured or non-insured.

Third – study the current infrastructure and competitive landscape of today’s health insurance model.  Look into changes that are possible than would increase competition, lower costs, provide greater access and maintain or improve upon America’s health care.  Consider:

  • Insurance provided as we now provide auto insurance – on an individual basis, not via businesses or groups.
  • Provide access to all health care insurers in the U.S to all people in the U. S. by allowing coverage to cross State lines.  Consider the advantages or disadvantages.
  • Tort Reform – it goes without saying that the cost of defending against frivolous law suits had burdened the current system.  Review and think about methods to reduce the incidents of such cases (by possibly creating a pay-as-you-go approach, the cost to be borne by the person or persons initiating the suit, and paid if the case is settled or lost in court.  Even in contingency cases require the party suing to provide a minimum payment to begin the case.).  Consider panels that review all cases, the service of this panel paid in advance by the person or persons bringing the suit.  Create further tribunals of review – peer review, to determine merits of cases.  Limit awards. 
  • Reduce the number of clinical procedures that ‘could have been’ or tests that ‘could have been,’ relying on the doctors judgements on needs to diagnose. 
  • Cause medical procedures to follow ‘best practices’, which according to the medical journals provide for the best outcomes, and require doctors to employ, learn if necessary, such practices and not rely on their tried and true methods if they are substandard, more costly, and result in longer recovery periods.
  • Insure generic drugs that are available when patents expire to be used and their costs the costs the medical reimbursement system uses, unless for some reason side effects or total effectiveness is not fully understood.  Costs above to be borne by the patient should they prefer the non-generic.
  • Require all persons be insured.  The problem of pre-existing conditions then becomes moot.  Pre-existing would be covered.  However if insurance structures vary, such as the size of the deductibles or the catastrophic coverage minimums, then transferring policies cannot receive better coverage if a condition exists at the time of transfer.  Upgrades may be possible for other than the pre-existing condition at time of change, and upgrades for coverage of the pre-existing after a time period or the condition no longer exists.  This is to avoid burdening the system with undue costs due to patient greed. 
  • If, as the current Administration states, there exists substantial fraud and inefficiencies in the current Medicare and Medicaid System, the they need to get to work and clean it all up.  Show us the money.
  • Consider the cost of the Unions on today’s system and make modifications to insure cross training and operating efficiencies prevail. 
  • Never forget the need for incentives and proper pay to attract quality health care workers, doctors and providers.

All of the above requires No Public Option and can evolve from our current insurance and provider infrastructure.  Government can impose the regulations and eliminate the regulations that current restrict the system and its efficiencies.  This needs to be eased into over time, with certain exceptions (tort reform, insurance across state lines, individual policies) to allow for the network to stay in sync with the demand.

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