The current health care system is threatening to spiral into self-destruction and take the U.S. economy with it. So, President Obama is right that the question is not "whether we can afford reform but whether we can afford not to reform our health care system." The current legislation has created a stalemate because many Republicans and moderate Democrats are loath to expand another government-run program at a time of record deficits. People at large are also skittish about leaving decisions about their health care in the hands of bureaucrats, accountable chiefly to lobbyists and political pressures.
Mr. President, in your State of the Union Address you said, "If anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know."
I have such a proposal. As a physician working within the system for 45 years, I have gained some deep insight into the many problems of our health care system. In fact, I have written two books whose receipt your office has courteously acknowledged. I've written several articles in the Huffington Post addressing our health and our economy. Here, again, I take up the offer that you made to the American people to present you with a better approach.
Mr. President, the present legislation skirts the most important weakness in our expensive and inadequate health care system: the profit motive. The problem, sir, is that ours is the only system in the developed world that is for-profit. The present legislation may line the pockets of insurance companies, doctors, pharmaceuticals and other providers, and would do havoc to our health and our economy. No wonder there is resistance to it. Please note, we must get away from a for-profit health care system. Greed is killing 98,000 of us each year as a result of medical errors. Unnecessary operations and tests are costing us a well-documented $700 billion per year. Please tell us, why can't we have a not for profit, independent, people-managed, accountable insurance co-op from which the government buys Medicare and Medicaid policies at the present rate, as described in Health and the Economy: A New One-Step Solution? Have any of your advisers read these books, whose receipt your office has courteously acknowledged?
Yes, sir, there is an alternative that will address the underlying problem. I have proposed a nonprofit, private, national coop, controlled and managed by its policyholders, i.e. patients, in my book Universal Health Care System for the United States. (Free download at www.behzadmohit.com.) It is a more politically feasible proposal than the current legislation.
The proposal involves setting up a national nonprofit cooperative insurance agency, owned and operated by the American people covered by its policies. If all the health care paid for by state and federal governments (i.e. Medicare and Medicaid) were contracted to this coop by the government it would have the immediate power to lower health care spending. Because such a coop would be large, it would provide access to a wide variety of doctors, so that doctor choice would be preserved.
According to CMS (Centers for Medicare and Medicaid Services), government funds pay roughly $1.2 trillion annually for health care. This coop would contract directly with doctors, hospitals, and other providers to deliver services. Doctors, for example, would be employed by the coop and receive salaries set by the median current income in their specialties and geographical areas. This model eliminates the current for-profit model, at least for government-financed programs. It also does away with the conflict of interest that results in excessive costs and poor care. It eliminates the need for billing. At present, public and private health care billing in this country cost more than $200 billion per year. The new system would also immediately stop fraudulent billing to federal programs, which is estimated to cost taxpayers an additional $60 billion per year. With complete health care coverage, including for pre-existing conditions, coop patients would no longer have to worry that payment would be denied after the fact.
The coop would also take action to lower costs and increase the quality of care through a quality control incentive program. Since this would be done directly by the coop, the incentive program would not cost the taxpayers a dime. Providers would be evaluated by randomly selected peer reviews blind to the identity of the doctors they review. Providers would be evaluated by patients. Those who are judged superior by their peers and patients would be rewarded by bonuses and acknowledgments. Those who are ineffective could receive supervision, be retrained, or dismissed from the coop program. All surgery would be digitally recorded for use in training and evaluation. This would also provide a record in case of claims of negligence.
The insurance coop would pay for all successful claims of malpractice. Providers would no longer need to practice defensive medicine to avoid malpractice suits, but rather would have to deal directly with the coop if they were found to be negligent. This would relieve pressure from the providers and give patients better protection.
Other industrialized nations that do not use a pay-for-service model provide their citizens with better quality health care at roughly half the price we Americans pay. (We rank 37th in quality of care.) The new coop would be able to match those lower per capita costs early in its operation. Individuals and businesses would be able to join the program at the same low cost that the government pays, with no co-pays or penalties for pre-existing conditions. The current legislation is estimated to increase the cost to the government by at least $90 billion per year. If the nonprofit coop proposal were instituted, the government would save approximately $500 billion per year. In addition, Medicare and Medicaid recipients would have superior care, including preventive care and medication.
One reason for this is that the coop would be able to negotiate for lower prices on drugs, devices and hospital costs. Americans are now paying up to four times the amount their industrialized neighbors are paying for the same products. An entity with the negotiating clout of a coop of at least 70 million people might be able to get a price even lower than other countries with smaller populations, e.g. Canada (about 33 million).
The coop would further lower prices in the long run by using its income to fund preventative care, research, and medical education. This would free medical research and education from the influence of for-profit interests, which have corrupted medical education and research since the 1980s.
This plan has elements that will please all segment of the population involved in this debate:
- It creates a nationwide plan that does not create more big government or bureaucracy and, in fact, would result in169 billion savings immediately, due to the elimination of administrative and fraud costs. Quality control measures would bring even more savings by eliminating overutilization and including preventive care.
- Policies would belong to the patients and could be moved from state to state, job to job, or to self-employment or early retirement. Policy holders would elect the management of the coop.
- Private insurance companies would be left in business, but would face competition that will drive down prices.
- The plan to lower prices is well defined and is not be based on spending federal or state funds.
- Health care quality would increase when the conflict of interest created by the FOR-PROFIT PAY-FOR-SERVICE model is eliminated, and doctors and other healers would receive the same pay to focus on patient care instead of filling out insurance forms, running a business, and practicing defensive medicine. Pharmaceutical and device manufacturers would be largely relieved from the estimated45 billion they now spend on marketing annually.
- US companies, large and small, would be relieved from the heavy burden of health care costs as they can buy plans for their employees from the coop at the same rate government pays.
- Industry would save more than100 billion that would have been lost due to poor worker productivity caused by inadequate health care.
- The average American would be able to afford adequate health care, and government savings would be high enough to close any gap and keep the government's expenditure frozen at the present level. The government would be able to buy policies for an additional 36 million people presently uninsured from the immediate169 billion savings on billing, administration, and fraud costs alone, without tax increases on other Americans.
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