Rebuilding America: Medical Reform
Over the weekend of September 11th, President Obama chided opponents of his health care reforms for being naysayers. He accused them of lying and of not offering alternatives.
The President’s claim is false. The following plan was prepared over five years ago when I ran for Congress in 2004.
The plan includes:
• The role of personal responsibility in health care and healthy lifestyles
• Changing the focus of health care from remediation to wellness
• Eliminating bureaucracy in Medicare and Medicaid billing
• Funding for education of health care professionals and
• Tort Reform
Since action has been delayed on the needed reforms, the crisis is more severe and the solutions more limited than they were only five years ago but rest uneasily for the medical care crisis is real and it is multi-faceted.
Today, the press and our leaders focus on cost and the uninsured. In reality, one should be more concerned about availability.
The number of doctors over age 55 is significant. When those doctors retire, the question will not be about cost of medical care but instead it will be about the rationing of medical care. The shortage of practicing nurses is already well known but the shortage of doctors is only now becoming a focus of discussion.
In order to revitalize our health care system and provide the solid foundation necessary for access to health care for all, our society must make major changes in how health care is thought of today.
The individual is the starting point for good health care. One cannot continue to rely on drugs or surgery to reverse years of poor health habits and poor diets. Parents should be encouraged to help educate children to learn good nutritional and physical fitness habits. The solution to our health care crisis is personal responsibility. While this will take over 50 years to reverse, we must start educating citizens or the real solution will never occur.
A health care system that focuses on illness is virtually impossible to support financially. Since personal responsibility and healthy lifestyles take time to implement, our immediate need for health care reform must be to change the system to emphasize wellness and not illness.
To implement a wellness program, it is important to allow nurse practitioners, physician assistants and nurses greater autonomy to assist in providing medical care at the patient level where care is best given at the least cost.
Health care research should focus on developing standard medical examinations and other diagnostic tests for each demographic group based upon estimates of medical needs for the particular group. This will improve early diagnosis and treatment at a much lower cost than remediation later. The value of maintaining good health rather than trying to restore health should be apparent.
Health care systems must be streamlined. The current bureaucratic systems do not encourage good health care. Microsoft, as an example, is working on an electronic health record which will provide needed, secure, information to the health care provider when the information is needed. The productivity gains which would result from a private solution to health care information management would be immense.
Immediate changes are needed in billing systems, tort reform, and tuition assistance to encourage medical careers.
To alleviate the shortage of health care professionals, Congress needs to encourage careers in health care especially for the aged. This can be accomplished with tuition assistance, loans, and tax incentives to reverse the decline in the number of nurses and physicians in practice. To reduce costs of medical care, it is crucial to increase the supply of health care professionals as well.
The tax code should be amended to reward those entering medicine. To fight medical care shortages, provide for the deductibility from income of tuition payments.
To provide for care to the poor, non-profit health care facilities will partially fill the gap but the tax code should be modified to allow health care practitioners to deduct the market value of their charity care to the poor as a tax deduction on their tax returns.
Medicare and Medicaid billing systems are so complex and the rate restrictions so severe that billing costs are over 4% of the health care dollar compared to ½ of one percent of commercial enterprises. More realistic rate structures and simplified billing administration are needed to encourage the free market system to work as they are intended to work.
Tort Reform is needed as well. We must limit non-economic damages for awards, and give the state licensing board greater latitude to punish negligence. Concurrently, physicians and health care providers have to be willing to police their own ranks.
Improving prescription drug approval processes and research are needed to significantly reduce the costs of developing new drugs. Making villains out of drug companies to get votes is counterproductive.
Finally, revision of HIPPA and the Stark Act to reduce unnecessary and cumbersome regulations which increase costs but do not improve health care should be undertaken immediately. Once again, the Congress passed well intentioned bills with no understanding of the impact on the industry.
Great health care emphasizes wellness, personal responsibility, and a society that is willing to lead the effort of encouraging health care careers. Bandages will not fix our health care problems today but redefining how health care is provided will. We need to break health care in order to fix it.
Col. Frank Ryan, USMC (ret) spent 9 years on a hospital board of directors and an additional 11 years in health care related governance activities. He is currently the President of the board of directors of a residential treatment facility. He can be reached at [email protected]