Let's Keep It Simple
I have tried not to editorialize or inject too many personal thoughts into DR T'S WEB LETTER, but there is an issue that has been bothering me like a rock in my shoe and you have heard the old anonymous saying: "A man can stand anything but a rock in his shoe."

I have a problem with the Health Care Delivery System in the United States and I think that it can be improved without too many complicated bureaucratic regulations.

First of all the system is multi-tiered. Certain citizens of our society have access to basic health care products that are unaffordable to other socio-economic groups. This is a reflection of the underinsured population and that group of citizens who have no insurance because they can not afford it or they do not qualify for government subsidized programs.

Necessary and basic health care benefits vary by age and gender. What is basic for a person 75 years old is not necessarily indicated for a person who is 35 years of age. It will also vary by gender and age in that particular sex.

I think the first approach is to standardize basic health care necessities based on age by decade and gender. Let Congress establish an ad hoc health care committee that is geographically representative and consists of Physicians, Epidemiologists, Hospital and Managed Care Administrators, and appropriate Government Officials. The Physicians should be engaged in the active practice of Medicine and from both the Private Sector and Academia.

These health care packages would be for preventive medicine or preventive maintenance if you equated a human to a machine. These guidelines would determine when a person needs a physical examination and what it should consist of. They would determine when and how often such procedures as endoscopy, mammograms, pap smears, and certain laboratory tests should be performed. Basic immunizations would be outlined and many other things that address good basic preventive medicine would be included.

Acute illness generally varies by age and most managed care organizations and the Federal Government have computerized data that reflects the incidence and severity by patient population. They also have data on the number of people with a chronic illness per unit population. Once the practical basic medical package is defined by age and number of insured lives then Medical Insurance Companies, Managed Care Organizations, and Physician-Hospital Organizations can put a price tag on the necessary coverage and let the American Public and Corporate America purchase the plans individually or in cooperation. The American Public needs to have some responsibility for their health and to what degree they participate in their health care will vary according to what they can afford. If there is a segment of the population that wants more than the basic package then let them purchase it. The extra luxury is not necessary but if they want it then they can pay the extra premium associated with that level of coverage. Citizen financial participation will be by co-pay for physician office visits or by a percentage of hospital charges and physician hospital care charges. Physicians' fee schedules and hospital reimbursement by DRGS should be standardized and vary only by geographical location. The fee schedules will generally be a percentage of Medicare and be negotiable.

Insurance premiums can be paid by employers or employer-employee combination. Self-employed will purchase their own and that price will again vary by age. Small businesses that can't afford health insurance for their employees will be a problem but perhaps some formula can be used to figure their level of participation. Government (State and National) subsidy may be necessary for this group as well as for the temporarily unemployed and temporarily disabled. Vouchers funded by the State and Federal Government will be utilized to pay for the basic health plans of the poor and disabled. Medicare will continue to be run by the Federal Government but it must consist of the same level of coverage that was established as basic for the age of the recipient. If the Feds want to put this coverage up for bid by Managed Care Organizations then they can work out the contractual arrangements, which will vary geographically.

Patients should have freedom of choice in physician selection and should also have access to specialty care especially in acute problems or in those situations where their primary physician lacks the expertise to deal with the problem.

There will be many other aspects of health care that must be addressed such as pharmaceutical coverage, long term care, and chronic illnesses such as Diabetes, Chronic Congestive Heart Failure, Asthma, Cancer, and Chronic Lung Disease. The chronic illnesses can be dealt with through a Disease Management Program but this will be up to the Managed Care Organizations, Health Insurance Companies, or Government as to how they want to manage patients that fall into this category.

How much will this cost? I'm not an actuary so I can not come up with a figure but I know it will be expensive. The American Public has to realize that high-tech modern medicine - and that's what they want - is expensive and that expense will continue to escalate just as inflation increases the price of all other products, but the rate of that escalation should be controllable.

My introduction said to keep it simple. I know that it can't really be simple - there are too many variables that contribute to the complexity of health care delivery; but it can be simpler than it is now and it certainly can be more fair than it is now. That is what the age-related basic health care packages provide. This would do away with the multi-tiered health care criticism and it should better delineate pricing.

Perhaps I am naive in my belief that a consensus of basic age related health care needs can be established. I discussed this idea with a friend of mine who is active in National Organized Medicine and he said that the AMA had tried unsuccessfully to do this several years ago. I think it needs more clout. It needs to be a congressionally mandated consensus and there needs to be legislation to support the concept. In some states automobile liability insurance is required by law. Basic age related health care insurance likewise should be mandatory. This would keep the health care providers from taking the financial hit associated with subsidizing the health care of the uninsured and underinsured and then passing the expense to those who pay for their health care.

There needs to be a team approach to address the health care problem in the United States. Each team player, whether they are Physicians, Hospitals, Managed Care Organizations, Health Insurance Companies, Government (State and Federal), and citizens must realize their position on the team and they must play fairly and ethically. The greed has to go. Investors should not be in the health market place. If a profit is made then it should return to the system in the form of research, education, or quality of patient care.

I feel better now. I removed the rock from my shoe. I have said what I wanted to say and I will be delighted to help or discuss my ideas with anybody who has the desire and power to change and improve our current Health Care System.

Take care until next time,
RJT, Editor.

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