I am a doctor and a disabled veteran. My wife is in remission from a life-threatening illness. She works as a consultant, a vocational rehabilitation counselor, and drug and alcohol rehabilitation counselor, primarily with Native American support agencies. We are both lucky survivors of medical errors. We are familiar with the health care system from multiple, diverse experiences.
A cardinal principle in medicine is to treat the illnesses that are apparent and treatable, while identifying and developing a treatment plan for those conditions for which a direct and immediate solution is not available. The patient’s health will improve, while waiting for the definitive cure. Applying this principle to the health care system, eliminating waste, expanding both consumer rights and responsibilities, and providing direct comparison shopping in a free market should be implemented and then evaluated, before a major overhaul of the health care delivery system is attempted.
To improve medical service in the USA, I recommend the following initial steps:
1. Eliminate any anti-trust law exceptions for the insurance industry. Eliminate price fixing within the industry.
2. Allow consumers to comparison shop health insurance by creating 3 or 4 nationally standardized policies with ascending levels of coverage, with uniform terms and definitions, providing direct competition between health insurance companies nationwide on the same benefit levels. This would also create larger groups of insurance subscribers, which should lower premium rates.
3. Require all health insurance companies to use the same standardized forms, coding, and consumer submission software, reducing administrative waste.
4. Encourage consumers to carry major medical health insurance coverage, and self-insure for routine medical care. This should reduce administrative costs and consumer expenditures substantially, by reducing the mounds of paperwork created by insurance processing of low cost claims.
5. Stop insurance clerks from making treatment decisions. Only a licensed physician can legally determine diagnosis, treatment, and when an illness initiated. Anyone else making these decisions is practicing medicine without a license, a felony.
6. Individual responsibility is essential for successful health care outcomes. Require co-pays of some sort for any government funded, non-earned, health benefits. Surprisingly, this would reduce the number of no-shows for appointments, which cause substantial losses for health care providers treating government insured patients. Services that are free or do not require a responsible commitment from the beneficiaries, are taken for granted, abused, and wasted.
7. Require participation in substance abuse treatment programs for individuals with those medical issues, in order to maintain eligibility for any government funded health care benefit.
8. Change tort laws to cap awards for other than actual damages in medical malpractice. At the same time, pursue criminal prosecution of physicians who are guilty of gross negligence, sentencing them to provide free care to the state Medicaid and similar agencies, with revocation of license and imprisonment for severe cases or multiple offenses. State medical boards, police yourselves or someone else will do it for you!
9. Expand Medical/Legal Review Boards to reduce frivolous medical malpractice lawsuits.
10. Treatment provided for medical/legal reasons rather than purely medical reasons is extremely wasteful and probably creates more risk than it insures safety. I don’t have an easy answer for this problem, but it warrants serious discussion. What risk level is acceptable when determining what medical tests should be conducted?
11. Stop providing free medical care to illegal aliens, we can’t afford it. Instead, expand care for US citizens who are physically, mentally, or economically disabled. Don’t let your own neighbors suffer while someone who disregards our laws is rewarded.
12. Pre-existing condition coverage guarantees should only apply when the condition was already covered by another private or government insurance program, and replacement coverage is being purchased. Otherwise, people will wait until they are ill to buy health insurance. This would be unfair to consumers and the insurance industry.
Waste does not treat or cure anyone. No matter what assets are available to commit to health care, we cannot afford to expend resources in non-productive ways.
