US Health Care Recommendations

One of my New Year's Resolutions this year (09) was to learn enough about the US health care system to form an opinion. I've read half a dozen books, (Daschle, Herzlinger, Porter & Teisberg, Emmanuel and others) a bunch of articles, had dozens of conversations with people who've experienced different systems and even seen Sicko.

And, six months ahead of schedule, I have an opinion. First, along with millions of others, (but not apparently the honorable representative from Ohio) I think our health care system is majorly broken. I think we need a health care system that:

1. Provides universal coverage. It's a national embarrassment to live in the richest country in the world by far and have 50,000,000 Americans without access to basic care. What they do is go to the ERs which is the most expensive basic care we could imagine.

2. Has everyone who uses the system contributing to it in proportion to their means. Taxing people who have more is a hard sell when illegal aliens and people off the tax roles are not contributing to the health care they get.

3. Preserve choice. Individuals should be able to chose the kind of health care they want.

4. Preserve private enterprise's engagement in the health care system. Americans want to be in business and earn from that. We don't want the government to administer health care. Preserve a multi-payer system to distribute the costs.

5. Remove the profit motive from health care. The problem with mixing profits and health care is that providers avoid the really sick and are encouraged to milk the system to their own advantage so that margins rather than health care becomes the foremost concern.

6. Reduce the litigious nature of medicine so that doctors can practice medicine with less concern about being sued by anyone who seeks a free income.

7. Enhance the development and collection of health records and data that would feed research into health care systems and processes.

8. Reduce the cost of the US healthcare system.

9. Protect the patient from predatory practice.

10. Provide universal healthcare coverage for all people within the United States at a basic level.

11. Snip the connection between healthcare benefits and employers. The cost of healthcare is a major drag on employers.

12. Encourage wellness among the population.

All of that is a tall order. AND here's a system that will do all of the above. It's not mine. I'll give credit at the end.

WHAT WE SHOULD DO THIS YEAR

1. Create a national health care board similar to the Federal Reserve. This national committee would oversee the rules and procedures governing the system. Appointed with a similar process as the Fed.

2. Create twelve health care districts each with a regionally appointed board to make regional application rules, adjudicate disputes, assign patients, collect data including the development of a universal health care record, conduct research, recommend to the national board. Law suits would have to be cleared by the regional board for legitimacy before they could be brought.

3. Anyone who resides within a region who does not have health insurance would be assigned to a private plan by the regional board. All patients would have the option every January to switch systems, preserving choice. Thus, every person is covered, private companies are responsible to their patients and cannot avoid sick people. Inefficient or ineffective companies would find their patients leaving. Effective and efficient systems would attract patients.

4. Premiums are allocated from a federal pool to private insurers according to their roll of patients and their needs. Hence, insurers who had more serious illnesses would receive more funds providing an incentive to attend to the seriously ill as well as to the not-so-ill.

5. Doctors and hospitals and other health care institutions would be compensated by the private insurers through private contracts. The better providers would command higher compensation and the better insurers would be able to pay them.

6. Install a federal sales tax of 8% on all sales of all finished goods and services that goes into, without exception, the federal health fund pool. Funds are allocated to the twelve regions based proportionately on the sales in their regions. In this way, everyone who lives in America is participating in supporting the healthcare system, but only according to their needs. Illegal aliens. Tourists. Diplomats. Drug dealers. EVERYONE who bought something would be contributing to the healthcare system. If you have a big income and want to buy a $500,000 car, you can. It will cost you $540,000. and you'll be contributing more to the health care system than the person who buys a $9,000 car for $9,720. Should the poor be made to contribute to the healthcare system. I believe anyone who uses a service shoudl contibute to it. Our own Ralph Waldo Emerson's SELF RELIANCE you know. This process also snips the connection between employers and healthcare costs (I know, just a minute).

The national sales tax requires some attention. Would it stimulate the development of a black underground market? Perhaps--we also have income tax evasion present in the country today. We'd have to monitor that. Would it create a sea-anchor/drag on sales and the economy? Maybe a bit, but I think it would be a short-term (1-3 years) dip and then we'd be "used" to it. More than the healthcare cost to employers today? I don't think so. Other countries manage a VAT and seem to be carrying on. Would the government try to siphon off the tax for other purposes? Of course. Hang those folks. Publicly. Yes, the ones we elected who steal from the pool--hang 'em. Not really--just throw them in jail for 30 years where they'll get free healthcare.

The biggest sticking point of this system is likely the source of funds--a national sales tax. But wait a minute, what are we paying for health care NOW? We have one of the most expensive, inefficient systems in the industrialized world. And what do we get for that? 34th in the world on infant mortality--for example. We're NOT getting the bang for our buck. The system described above would press relentlessly for improvements in the system by encouraging efficiency and quality without sacrificing the sick. It would allow ALL who benefit from the system to contribute to it retaining a sense of dignity and membership. It would allow us to do much better research on better healthcare methods and procedures. It would reduce frivolous litigation. It would reduce cost. It would encourage the formation of small businesses in healthcare AND release the drag on non-healthcare entrepreneurs.

We need this system NOW. And my thanks to Ezekiel Emanual and his book, HEALTHCARE, GUARANTEED for striking to the heart of the issue(s). I WISH President Obama and Speaker Pelosi would read this book TODAY. How could any of we Americans be opposed to adding 8 cents to our bill the next time we buy coffee or a donut to help get people off the streets and out of the gutters when they cannot afford healthcare? Our current system is NOT taking care of our own. And our economy is three times larger than the next largest one. Shame on us for being so insensitive.