Healthcare Reform 2013
Americans are now nearly two months into the implementation of ObamaCare. The abject failure of our government to produce a workable website, let alone a revamp of our health care system, should be pretty obvious to just about anyone.
What comes next? Assuming the website becomes at least somewhat workable, it should be equally clear that nothing close to seven million people will choose to enroll and, conceivably, we will have more people with cancelled policies than are able to get new ones.
In the next few months, we will also see if the ACA will be able to effectively implement enrollment, correctly indentify membership, and recruit enough physicians to see these newly enrolled patients, manage their care, evaluate the efficacy of the care provided and hold down costs for 2015 members. I wish them luck. They most assuredly will need it.
What would a better program look like that could replace ACA and restore American’s belief in government and integrity in its leaders?
The goal for any healthcare system should be to simplify the marketplace, create certainty and transparency, and ensure no American ever goes broke because a serious illness or accident befalls them.
All Americans have heard stories about solid families that have, through no fault of their own, become bankrupt because of enormous hospital/medical charges. All Americans know that a catastrophic illness can devastate a family’s financial resources.
Therefore, the big first policy change to help all Americans is a universal catastrophic policy. We should establish as a nation that no one should ever lose everything they have worked hard for just because of a catastrophe.
Establishing an absolute limit of 20% of a family’s/ individual income per year that can be spent on any catastrophic illness, accident or insult per family is the first step. After reaching that 20% threshold, all further associated expenses would be the federal government’s responsibility. The Robert’s Court has already ruled that the government has the authority to tax its citizenery for this type of mandate. The relative expense for this type of insurance would be modest.
Secondly, our community health system must be used to help physicians everywhere understand the appropriate use of testing, imaging and procedures that are both efficient and effective to provide patients appropriate care at the appropriate time. Private practices that have had tremendous success in their models must also be used to help physicians truly understand the best treatments for their patients. San Antonio, for example, provides some of the most effective, efficient, and patient satisfying senior care rendered anywhere in the US. It can and should be used as a model.
Physicians, hospitals, and healthcare providers must radically shift from fee-for-service to a “value over volume” approach. We must analyze every procedure, test, surgery and physician encounter to make sure we are truly receiving value not just volume of testing. Many technological improvements will help make this possible including the sharing of test results electronically. We must move our physicians into the 21st century by actually paying them for telephone or email consultations and supply them with the data that will allow them to seek only the most effective/efficient treatment for their patients.
We should reexamine the role of all health care providers, seeing if there is an effective method not only to increase the supply of physicians and nurses but also redefine the role of physician extenders like physician assistants, nurse anesthetists and all the rest that can help handle not only the new patients into the system but established patients as well.
Adding new patients to our system will require more healthcare professionals. Currently we have a shortage of 22,000 primary care physicians and 178,000 nurses. Not one dime has been raised or for that matter even suggested by anyone, to educate significantly more health care professionals. Only 2% of this year’s medical students have chosen Family Medicine as their specialty. We must do better to attract primary care physicians to take care of our 320 million citizens.
We must institute tort reform. Analysts sometimes claim that malpractice payouts are too small to consider when thinking about overall hard costs of healthcare. They seem to forget that physicians all across the country play defensive medicine every day. CT scans, MRIs, and technologies of all sorts are overused constantly in the name of insuring against malpractice. We must address this problem. We can hold physicians/hospitals and others accountable for their errors, but must find a way to end unproductive healthcare expenses in the interests of reducing medically frivolous lawsuits.
As a nation, we must begin to assume responsibility for our own health. Obesity rates for our country now show 34% of us are grossly overweight. We have long known that five of the top seven killers of Americans are directly related to obesity. We must lose weight, increase our exercise, eat better and live as if we are the people most responsible for our own health.
As unpleasant as it may sound, we must consider not only raising the age for retirement, i.e. Medicare, Social Security, etc., but consider means testing for our more affluent older people. Entitlement programs now claim more than one-half of our national budget and healthcare spending is 22% of that number. If we don’t address this problem, there just will not be any money left for education, defense and all the other items in our national interests.
There are some useful benefits of ACA that should be retained. Most people like the notion that we have eliminated preexisting conditions, that young people can stay on their parents plan, an emphasis on preventative care, and that there no life time limits on coverage. But Americans must also understand that these features cost real money and that every time a mandate is added to the list of covered benefits it increases premium costs by a half of one percent.
We should allow state exchanges to create more efficiently by allowing insurance companies to cross state lines and offer their most efficient system to enroll patients in any area that they seek to engage in business. We can foster competition, cost efficiency and efficacy in that manner without federal involvement.
We now know this much for sure, Americans deserve a reasonable, responsible plan to broaden coverage for all, a guarantee that no American goes bankrupt because of an illness and that all of us have a broader responsibility to take care of our own health. We might want to consider these changes as a better solution to the current government-made mess.
