Dr. Clif Cleaveland, Commentary
I believe that access to affordable medical care of high quality is a basic right of all American citizens. Without decent health care, there is little chance for “life, liberty and the pursuit of happiness.”
For many Americans, this right cannot be realized in our fragmented, increasingly expensive system. Market forces can no more fix health care than they could prevent our current economic struggles.
After extensive reading and conversation with friends, readers and former patients and colleagues, I propose a six-point plan for reforming our health-care system.
n Establish a federal health board along the lines of the Federal Reserve. This nonpartisan panel would license and monitor health insurance plans for quality, assess and approve the deployment of new medical technologies and establish manpower policies to meet the need of the public’s health.
The board would establish standards of care, thereby reducing waste, fraud and abuse. Careful analysis of cost, benefit and safety would determine which new technologies should be approved for general application. To correct a worsening shortage of primary care physicians, the board would balance training program slots against needs and devise incentives for health professionals to practice in underserved areas and understaffed specialties such as family practice.
n Use the Federal Employee Health Benefit Plan as a uniform model for the nation’s health insurance plans. Plans would be offered and administered by established, private companies.
The plans would offer uniform benefits at each of three levels of care: An HMO option with lower co-payments and deductibles, a mid-level managed care option with broader choice of provider and higher co-payments and deductibles, and a high-level option with the widest set of choices and highest copayments and deductibles. Benefits would be stated in clear, non-technical English, without waiting periods or exclusions for pre-existing health conditions.
Copayments and deductibles would be established by the Federal Health Board. Customers could change their coverage without penalty on a yearly basis. A company would be free to offer additional benefits beyond the required coverage. A company’s performance would be subject to yearly evaluation.
n Revise federal plans. Maintain Medicare in its current form but eliminate private Medicare Advantage options which currently receive costly supplements. Fold Medicaid and state children’s health programs into private plans through vouchers pegged to income levels of the recipients. Because of the often special needs of military veterans the Veterans Administration health system should be maintained but strengthened to provide better long-term and psychiatric care.
n Deploy a unified electronic billing and medical records system. Each participant in the care of a patient must cope with complex billing protocols that often delay resolution of medical charges for months, even years. A single, electronic billing system would offer simplicity and prompt payment for services, thereby dramatically reducing administrative overhead in clinical care. Patterns of charges could be monitored to identify issues of over-use or under-use of clinical services.
Stacks of often illegible documents constitute the medical records of most of us. A system allowing immediate access to a patient’s clinical record by all professional participants — physicians, pharmacists, hospitals — would allow safer, smoother and more timely care. Quality of care could be more easily measured. Medical errors could be identified more quickly. If a newly released medication caused previously unsuspected side-effects, this could be established more readily.
n Implement new programs in public health. Obesity with its many related disorders represents a major threat to the nation’s health and economy. Sexually transmitted diseases such as HIV claim tens of thousands of victims annually. Violent behavior, drug and alcohol abuse, and unhealthy lifestyles exact high tolls of suffering and premature death.
Health education must be added to basic academic instruction at every level of schooling. We should test the feasibility of a nurse-educator as a staff member of elementary and secondary schools.
n Reform medical liability. The monetary awards in medically related litigation are a small part of our nation’s total expenditures for health care. Fear of a malpractice suit, however, leads care-givers to overuse technology and to employ excessive consultations to cover every possible cause for a patient’s symptoms. This very complex issue should be addressed initially by an expert panel of attorneys, judges, health care providers and community representatives to search for alternative methods to reduce medical errors and to compensate victims of faulty medical practice.
Changes will be costly in the short term. A streamlined administrative system; reduction of errors, waste and abuse; and improved preventive practices will reduce costs and improve quality of care over the longer term. I will consider individual components of this proposal in subsequent columns.
Contact Clif Cleaveland at firstname.lastname@example.org.