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Improving Health Care in the United States

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by Thomas A. Stobie, SFO

Prelude

I will address some major areas where health care can be improved in the United States. This entails identifying major problems in the current health care system and then providing ways of addressing these problems.

From a federal government point of view, I would call these collectively "Diverse Free Market Consumer-Driven Health Care". We need to take the politics out of medicine. Currently our health care system behaves more like a monopoly than a free market and the best care is reserved for the wealthy.


Table of Contents


Problems with the Health Care System

  1. Lack of Consumer Awareness of Medical Pricing - Most consumers are unaware of what medical care costs or the availabilty of lower cost options to the medical care that they receive. Many medical plans isolate the customer from the true costs of the service and use co-payments that do not vary with the cost of the service.
  2. Excessive Government Restrictions and Requirements on Health Care - In many areas, government require medical plans and providers to include certain services even if they are morally opposed to the service.
  3. Frivolous Medical Lawsuits - There are way too many lawsuits about medical malpractive encouraged by lawyers hoping to make a quick buck.
  4. Unaffordable Health Care for Many - The current system makes it hard for the poor to select low cost health care that covers basic areas or covers emergency or life threating situations.
  5. Lack of General Health Care Coverage Options - The current system encouraged by government regulations generally treat all consumers as if they want the same coverage "one size fits all". There is some consumer choice in whether to use a HMO, a PPO, or a general medical insurance and some have the option of a Medical Saving Account, but these tend to follow the same mold and not a great variety in the options of health care available.
  6. Lack of Diversity in Medical Oversight - Overseeing Medical Associations, whether government based (federal or state) or non-profit organization, currently are monopolistic in nature, and tend to advocate views based on politics rather than true medical science.
  7. Excessive Medical Pricing - In many areas, primarily where competition is limited, medical prices are excessive and prey on consumer by encouraging their fears or providing incomplete information about the product. Comparitive analysis between products is not widely available.
  8. Poor Handling of Pre-existing conditions - Health care plan providers often use pre-existing conditions as an excuse to avoid covering particular medical problems.
  9. Lack of Electronic Exchange of Medical Data - Doctors and hospitals do not share their medical information electronically with each other about the patient resulting in excessive form filling, data entry, lack of knowledge about the patient's medical history, and lack of knowledge of prior test data.
  10. Fraudulent Abuse of the System - There are people who take advantage of the system by submitting false claims.


What can the Industry Do

Provided that the government permits free market activity in the medical industry, it should:

  1. Develop Health Care Plans that allow the consumer to be more aware of medical prices.
  2. Develop Health Care Plans that permit choice in how medical malpractice will be handled. - These could be ligiation, arbitation, overseeing bodies, etc. that would investigate claims of malpractice and take the appropriate actions and provide recompense to the victims. These should include ways for consumer to appeal the decision if they feel the problems are not being addressed.
  3. Develop Health Care Plans that address the specific needs of different groups, including religious affliation and those with limited budgets.
  4. Affliate with Medical Associations that share their moral views and disaffliate with those who do not.
  5. Form Medical Assocations that advocate a particular moral view to provide guidance to likeminded medical professionals and organizations.
  6. Provide consumers with detailed medical pricing for the services that they recieve and how they can save on what they pay through different options.
  7. Establish Retirement Health Care Accounts (RHCA) - RHCA's are accounts funding future health care coverage at retirement. At the time of retirement, the value of the account should be equated into a level of contribution towards health care coverage. 40 years of contributions to the account by employers should yield a low-copay full health coverage plan.
  8. Establish a common medical information exchange standard, that permit the communications of medical records between medical professionals.


What can Government Do

Here Government refers to the federal and state governments. The federal government needs to insure that state governments do not violate freedom of conscience rights of medical providers and personnel.

  1. Permit Medical Providers to Choose what Services/Products they Provide. - The government should permit all medical providers including pharmacies to choose what services and products they will provide and which they will not. They should be able to exercise and abide by the own moral views. No government should force the offering of any product or service that the provider morally objects to or feel uncomfortable offering.
  2. Encourage Diversity in Health Care Plans - The government should permit and encourage health care plan offers to provide a wide variety of plans, including (1) plans designed for specific groups, such as people of the same moral bent, (2) options on how medical malpractive would be handled (ligitation, arbitators, oversight boards, etc., (3) the amount of coverage (comprehensive with low deductables, umbrella with Medical Savings Accounts, umbrella catastrophic coverage only, etc.), and (4) coverage exclusions (cosmetic surgery, contraceptives, abortive services, certain transplants, etc.).
  3. For government provided health care, provide a diverse set of health care options - Revamp medicare, medicaid, and government employee insurance to include a wide diversity of health care plans, including some that encourage consumers to better manage the cost of their health care.
  4. Encourage Diversity in Health Care Oversight - Government should permit multiple health care oversight organizations to monitor and guide health care. This should allow for faith-based assocations as well as secular ones. This would medical organizations that want to offer a particular flavor of health care to be assocated with and monitored by oversight organizations that share their moral views.
  5. Transform Medicaid into two parts, (1) a Tragic Care Umbrella Plan, and (2) a Preventative Health Care Plan - This transformation will permit Preventative Care for poor children and the disabled while covering catastrophic medical problems for those poor not covered by employer plans or who cannot afford their part of their health care coverage. The Tragic Care Umbrella Plan should be restrictive in what it covers and where and should only address situations where the life of the person is at severe risk. Medicaid for citizens should have better coverage than Medicaid for resident aliens, which should be much better than Medicaid for alien visitors, which in turn should be far better than that for illegal aliens.
  6. Permit Disabled Individuals to buy medicare for their dependents. - Currently dependents of individuals receiving disability from the government receive medicare but their dependents (children and spouses) do not. The Disabled should be able to buy a a reasonable cost (for them) medicare for their dependents.
  7. Permit buy-in into State and Federal Health Care Plans - Residents and workers in a state should be able to buy into State health care plans. Likewise, residents and legal workers in the United States should be able to buy into Federal health care plans. Businesses should be able to buy into state and federal plans where their employees live and work. All federal and state plans should be available to be bought into with possible subsidies for low-income workers.
  8. Define that patients own their medical records and require all providers to make them available to be sent to other medical providers at patient requests and securly and confidentially for government investigations of wrong doing. - Currently medical records are not shared well, no electronic exchange standard for them exist, nor are most automated. The government should encourage the development of an electronic medical record exchange standard, the use of personal medical record repostiories that individuals could carry (such as on their keychains). Develop laws to prevent illegal access and use of medical records.
  9. Establish National Health Information Databases - The government should establish nationals health information databases to hold and share medical information about its citizens and residents. The intial work of developing the database standards could be paid for by a per patient tax (like $1/person/yr) on the medical insurance/coverage plans (including Medicare) followed by a multiple contract to 3 vendors to provide a repository paid for by a per person fee on the medical plans.
  10. Promote Better Handling of Pre-Existing Conditions - The government should allow the cost of pre-existing conditions to be spread out among all health plan providers for the last few years.
  11. Require Pharmecutical Companies to license at a reasonable fee, patented products to promote competition. - This license should consider the cost of the research in the products, but not the advertising or marketing costs of the products.
  12. Promote flexibility in Medical Savings Accounts (MSA) - MSA's should be flexible and allowed to cover families and groups, be inheritable, and be completely tax-free. The government should encourage employers to fund them for their employees.
  13. Promote the establishment of Retirement Health Care Accounts (RHCA) - RHCA's are accounts funding future health care coverage at retirement. At the time of retirement, the value of the account should be equated into a level of contribution towards health care coverage. 40 years of contributions to the account by employers should yield a low-copay full health coverage plan. These should be tax-free and the federal government should encourage private insurers to create and manage them.
  14. Permit Full Deductability for all medical expenses - All medical expenses, including dental and optical, should be non taxable.
  15. Permit Full Deductability for all gifts to pay medical expenses People who pay other people's medical expenses should be able to fully deduct such payments from their income.
  16. Establish Standards for Health Care Facilities - There should be many classes of health care facilities based on the type of care provided, the quality of care provided, and the ability to respond to unforeseen medical problems. Not every location needs to be able to handle all emergencies, but should have plans on how to address the ones likely to occur (The plans can include using another facility to provide it). There should be diversity of classifications for locations providing similar services.
  17. Establish Heavy Penalties for Fraud - There should be heavy penalities for fraud that include personal liability for fraud committed even on behalf of a business. In general, anyone caught defrauding the Federal government should be required to pay the government at least 10 times the amount of fraud, serve prison time, and be watched carefully from there on. It would be beneficial if the same sort of penalities could apply to any fraud within the medical community.
  18. Provide Caps on medical Litigation Awards - Some litigation awards are way out of proportion to the damage done. Caps on awards should be established to better manage the cost of malpractive insurance. Medical personnel who regularly perform medicine poorly should be restricted in what they can do in the profession.
  19. Establish a government assistance repayment tax - see the separate webpage describing the Government Assistance Repayment Tax.


What can Employers Do

  1. Provide a diversity of subsized health care options for their employees.
  2. For smaller employers, they can band together into communities to share in health care plans.
  3. Better educate their employees on how to manage the cost of health care.
  4. Fund Retirement Health Care Accounts (RHCA) for their employers


General Discussion

By improving consumer awareness of health care costs and promoting more diversity in the health care industry, the free market system should promote lower health care costs and improved health care for most Americans.

There will be consumers who do not want to take the effort to better manage the cost of their health care, but many will. Some will not be able to manage it, but hopefully their plans will guide them in cost-effective high quality medical decisions.

Health Care plans may move to more resemble auto insurance where they are may options that may be selected and discounts for good behaviors (such as non-smoking).

While there will be those, who in the effort to make money, will provide low quality care, overall the health care system should be significantly improved.

It may develop under the free market, two or more major flavors of healthcare, differentiated by the moral views of the providers and consumers. This is fine. Many Christians today feel that many providers are unethical today by the type of medicine practiced (providing/recommending contraceptives for example) and the result on the patient, their families, and the overall community and do not want to use these providers if they can help it. Likewise, many people living a lifestyle of getting the most out of the moment, want providers to assist in this philosophy and object to the ethical providers who will not assist them in this.

In the last few decades, politicians has used the medical industry to advance their own political views at the expense of the American citizen. Exemptions are granted in law and in government practice (against the law) to subset of medicine that advocate certain political views. This needs to stop, but will not with the current state and federal government leaders, so diversity of view most be allowed for and freedom of conscience must be permitted.

The federal government over time should see cost savings in healthcare they provide and may be able to expand its coverage for the poor and disabled.


Other Comments

The news program 20/20 had a report in late summer 2007 on the health care situation in the United States that illustrated some other problems with the current system in the United States as well as the problems with Governmental provided universal care, such as in Canada.


2007-2008 by Thomas A. Stobie, SFO - permission to copy for personal use is granted.


Go to my thoughts on policital issues webpage.


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Last modified on 23 Dec 2008.