America is desperately in need of health care reform. The current system is not cost-effective, not financially sustainable, and by default is being changed in a major way.
Health care funds that are currently allocated from federal, state and local sources could go a long way toward covering all Americans if used correctly. A nation that spends 16 percent of its gross domestic product on health care cannot compete in the world as we know it today.
If this burden is placed on the backs of businesses at a time when our productivity as a nation is declining, it will only delay economic recovery.
Probably only one-third of our health care dollar is spent in a way that it either preserves or improves the health of individuals. The administration fee of Medicare is smaller compared to what it costs to administer private health insurance.
Most seniors are satisfied with Medicare coverage. Americans who are insured have little skin in the game to incentivize them to preserve and improve their health or control costs.
What needs to be done is rather simple and does not require a 2,400-page morass (the Affordable Care Act) that few congressmen or citizens have read or understand, and more than 50 percent of Americans want to repeal.
Consider the following simplified alternative:
Every American would be covered by Medicare funded by a national sales tax of 5 to 10 percent.
No Americans, including congressmen, would be allowed to have any other form of health insurance to include supplemental insurance.
Medicare would be administered as it is currently, with no pre-existing clauses or other discriminating factors such as lack of portability.
There would be a 10 percent copay up to a catastrophic level of $50,000 in charges ($5,000 maximum out of pocket per individual per year) and it would start over every year. There would be no copay above $50,000 in charges.
All copays would be payable to the federal government as a government obligation, as are income taxes. It would be illegal for any biller or related entity to pay the copay. Only unrelated charitable organizations, family or friends would be allowed to provide copay assistance to individuals.
There would be no waiver or reduction of copay for anyone no matter what income level or illness.
There would be no separate programs for medicines, physician charges, screening studies, durable equipment or specific illnesses. The above coverage applies to all covered medications, durable equipment or procedures.
All medical records must be changed to a single comprehensive medical record system so all authorized providers have access to a patient’s entire database.
All patients must have a primary care physician (nurse practitioner, physician assistant, family physician, pediatrician, ob-gyn or internist) to access any aspect of the system. To see any specialist and have insurance cover it, you must go through your primary care provider unless it is an emergency.
Any American should have the right to obtain medical care outside the system, realizing that there would be no Medicare insurance assistance with this. Providers could freely operate inside and outside the system, but outside the system they must provide their own malpractice coverage.
Every medical school, NP or PA class should have half of its class contractually committed to a career in primary care as part of their acceptance. The provider’s national license would be based on this commitment. The receipt of federal funds by medical schools would be dependent on this.
Medicare would be the malpractice coverage system and no provider or hospital would have personal liability in the system. All malpractice claims and payments would be through a system similar to a worker’s compensation model. Providers and hospitals would be sanctioned or eliminated based on the decision of the above board.
Provider licenses would be renewable yearly based on a monthly ongoing national computer interactive continuing education program for each specialty and sub-specialty to maintain universal competence, and not on every 10-year testing designed by a variety of self-preserving specialty boards.
Provider compensation would be based on years of training and volume of direct work, not on diagnostic tests.
Initial provider licensure should be done at the national level, eliminating the inequality of state license boards and certifications by various boards. Therefore, a license would be portable from state to state.
Medicare would be a balanced budget pro- gram based on the yearly revenue received from the sales tax.
Only U.S. citizens would be eligible for coverage under Medicare program.
The above changes likely would drop the cost of medical care to less than 15 percent of GDP within five years. It would preserve the private medical system and its efficiencies.
It would allow patients (including all veterans) to choose their providers and hospitals. It would financially motivate patients to take an active role in their own health care.
It would provide universal coverage to all Americans and take the health care burden off of business.
It would improve the quality of American medicine overnight.
The writer is an Augusta physician specializing in internal medicine.