|To the Editor: We need to re-think how health care is delivered|
|Written by W.E. Feeman, Jr, MD|
|Wednesday, 16 September 2009 08:34|
The American health care system is the finest in the world - for those who can afford it. It would be a shame to destroy it in the name of making it available to everyone. What is needed is a reasoned approach so that the unintended consequences of good intentions are minimized and the intended consequences are maximized - in other words, a radical re-think about how health care is delivered. I am married to an English lady and I have seen the English system at its best and worst. The USA does not want to repeat the English errors.
May I offer a few suggestions:
1) The government should set up a health care system with a defined benefit package. (People desiring medical services beyond the basic package could buy insurance to cover those extra features.) The government should act as a central payer for that basic benefits package, working through existing insurance companies.
2) All would be assigned to a primary care physician who will act as the gatekeeper. If a medical problem arises that is beyond the capability of the gatekeeper, referral could be made to the appropriate specialist. People would be allowed to keep their own physicians, but all would be assigned to a gatekeeper. Any person desiring to change gatekeepers could do so at will.
3) Malpractice claims would be handled by the government. Any physician guilty of gross negligence would be stricken from the roll of gatekeepers.
4) As much medical care as possible would be rendered as outpatient care. Emergency room visits for non-emergency care would not be paid by the government. Employers would be forced to allow employees time off work to attend gatekeepers' offices during office hours without accruing "points."
5) The system would be financed by having employers pay their health care premiums directly to the government. For those who work but have no health insurance, a reasonable premium could be charged and paid directly to the government. The states would pay welfare premiums directly to the government. The tobacco industry would be forced to pay for those diseases it causes, as would the alcohol industry. Medical premiums could be reduced for those people who do not smoke, reduce alcohol intake, and/or lose weight. Those who participate in preventive medicine programs would also have lower premiums when their cholesterol, diabetes, and blood pressure disorders have been treated.
6) Payment for medical services would be on the basis of diagnosis-related groups.
This letter has been reduced in length to satisfy space limitations. I would be happy to elaborate.
W.E. Feeman, Jr, MD
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