Some time ago I told you how I could cut health care costs in half and provide every
American with the healthcare they need (not necessarily the healthcare they want!).
Here goes. Some of my points might seem drastic, but we are facing a drastic problem.
1. Immediately introduce national healthcare for all Americans ( and ONLY American citizens
and H1B visa holders ) which will be paid for by
an immediate TAX INCREASE.
2. Like Canada, this will cover all doctor's office, E.R., clinic, hospital etc. visits.
Unlike Canada (the biggest mistake Canada made), there WILL BE co-pays for routine office
visits and visits to the E.R. that are NOT serious emergencies.
Here is why Canada's no
co-pay system is wrong. A family physician friend of mine in London, Ontario had a family
in her practice. The little girl got an ear ache, with a low-grade fever on a Saturday.
The mother took her to an E.R. and got an antibiotic prescription. On Sunday the girl was
feeling better with no fever, but the mother took her to a walk in clinic "Just to make
sure everything was all right". The doctor said "Yes". On Monday the mother took her
daughter, who was now feeling fine, to my friend's practice "Just to make sure the other
doctors knew what they were
doing". The ear infection was cured.
That was two totally unnecessarily visits the
Canadian tax payers paid for, and the first visit should
have been to the walk-in clinic, which is much cheaper than the E.R.
Co-pays have to be meaningful - not too much to dissuade
patients from necessary care, but enough to make them think. That should apply to
all aspects of healthcare.
Let me give you another example - right now, where I live,
a basic ambulance ride (no drugs or treatments) is about $500. I have had a patient come
in by ambulance for a TOOTHACHE. The paramedics should be able to say "No" and not worry
about being sued.
3. Like Britain, every person will choose a primary care provider, who will provide their primary care. Referral to a specialist will require a
request for consultation from the primary care doctor. In the U.S., there are no restrictions on seeing specialists who charge twice as
much or more than a primary care doctor. I saw a guy who went to an ear nose and throat doctor to have his ear wax cleaned - a procedure
any nurse can do!
4. Immediate tort reform. Not quite sure of the details, but I estimate that probably 50% of the tests done in the U.S. are to C.Y.A. against
malpractice suits, and are medically unnecessary. What would probably be best would be a no-fault system. You are injured by the health
care system, you are compensated a REASONABLE amount for your injuries, regardless of who was or wasn't at fault. You aren't really
injured, you get nothing. This could be handled by arbitration panels which would take the lawyers out of the system.
Right now, it takes on
average $50,000 to defend a doctor against a frivolous lawsuit - the doctor wins, but still $50,000 is down the drain. On the other hand
I was involved in a suit where a patient died due to real negligence on the part of two doctors and the family lost the lawsuit and got nothing.
This would cut malpractice premiums by at least 1/2 and drastically reduce the amount of testing.
5. We spend WAY TOO MUCH money on end of life care. We have to get together as a society and decide what we will and will not
provide for end of life patients, and that doesn't just mean cancer patients, it also applies to end of life heart failure patients, emphysema patients, etc.
For example, a reputable study in The New England Journal of Medicine showed 0% survival from treatment of cardiac arrest on kidney
failure patients on dialysis. Zero. I have had to do numerous "codes" on kidney failure patients on dialysis - they all died. A code costs
thousands of dollars. The first code I ever ran was on a 38 year-old accountant having an acute heart attack. In the old days (1960's)
I would have simply pronounced him dead. He lived, and was FINE, no brain damage from loss of oxygen, walked out of the hospital a
week later and went back to work. That was money well spent. We don't have infinite money. We need to get the most bang for the buck.
The $90,000 chemo drug that extended terminal prostate cancer patients' lives by 6 months should NOT have been paid for by taxpayers'
money. Patients who want it should have to pay for it themselves.
6. We have GOT to get the gold-bricks off disability and workmen's comp. If we did, we could put the truly disabled and injured-on-the-job folks
in suites in the Ritz Carlton with 24 hour nursing and rehab care! It is mind boggling to see how many gold-bricks there are.
I really
liked the system in Ontario, Canada. Any primary care doctor could certify a patient as disabled or off work for up to two months. After that, the
patients had to be seen by a panel of specialists paid by the government. They had NO INCENTIVE to either certify the patients as
disabled/unable to work or not. To make these specialists truly independent they should be salaried - and the government CANNOT fire
them except for the reasons that would cause them to lose their license (sex with a patient, drug addiction, etc.).
7. All advertising immediately banned. We go back to the 70's. No doctor, hospital, clinic, drug company, can advertise to patients. Period.
8. All new drugs have to be compared to existing drugs (if there is a similar existing drug). ONLY if they prove superior to existing drugs
should the FDA approve them. Every time a new drug is invented, all the other pharma companies copy it, change a molecule or two,
and then study it compared to PLACEBO. We end up with 20 drugs that do the same thing. It's ridiculous.
9. Get rid of fraud and abuse - for real. This means doctors AND patients. You get caught committing health care fraud you pay in fines
THREE TIMES what you stole, and spend a minimum of ONE YEAR IN JAIL OR PRISON. This is crucial - fraudsters MUST be made
to do time.
Everybody's charges get audited by an independent panel. You charge for patients you didn't see, or wheelchairs you
never provided to patients - you go to jail. It must be recognized that nobody is perfect, mistakes happen. A doctor accidentally charges
for a patient they didn't see once in five years is not fraud - it's a mistake.
In the same way, patients caught "doctor shopping" for
narcotics and selling them pay three times what they made and go to jail for a year. Same for patients selling blood pressure pills (this
is a big racket for Medicaid patients) - doctors are usually suspicious of healthy looking patients seeking narcotics, but see a Medicaid
patient who is on expensive blood pressure pills, says they ran out and can't contact their doctor - they will usually get a prescription.
You can make a nice income on welfare doing this.
10. Eliminate health insurance companies, except for people who want to buy extraordinary coverage like for the $90,000 prostate cancer
drugs. Do like we did in Ontario - fee for service with the fees paid by taxpayers via a Department of Health, the fees negotiated
annually by either state or national medical associations.
11. Electronic medical records THAT WORK. Right now we are in the "pre-internet" era of EMR. There are a thousand different ones,
they are very expensive, doctors pay the full amount, and NONE OF THEM CAN TALK TO EACH OTHER. I worked for a long time in an
ER in Florida in an area where elderly people from the north came to winter. They would get sick all the time and come in not knowing
their allergies, meds, or medical history. It was a nightmare. If I hear
"I'm on a little white pill for blood pressure" one more time I may
scream!
With a national standard EMR I could find everything I needed to know with a few mouse clicks. It will be a disaster if this
info is stolen or hacked, so the punishment must be severe - TEN YEARS in prison WITHOUT PAROLE, and a hefty fine. No excuses.
Set up something with Interpol and the UN so this applies to all countries. And, since EMRs would benefit patients, doctors, and the
entire country, doctors and hospitals pay half, the government pays the other half.
12. Get rid of the bad docs/nurses/hospitals/ etc. I'll just speak for the docs here -
there are two kinds of bad docs - ones who are bad
usually due to lack of knowledge or drugs/alcohol but WANT to be good, and those
who are bad and don't care. The second ones
are immediately banned from healthcare for life. The first group gets extensive
education/rehab, whatever they need. Then close
monitoring. In my experience, most of them will turn out to be good docs.
A few won't, and get banned from healthcare for life.
13. Finally, immediately outlaw high fructose corn syrup and foods made with trans fats.
We know they are poisonous. Again, minimum one
year prison for the CEO and board of directors of any company that violates this law,
whether it's a mom and pop shop or Kellogs or McDonalds.
That's it, except for a few tweaks. Fifty percent cheaper, everyone gets what they need.
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Resistance, Revolution, Liberation: A Model for Positive Change
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