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Dr. Paul Toffel

Dr. Paul Toffel

Posted: August 13, 2009 08:46 AM

Health-Care Reform: An Original And Simple Proposal


With over 300,000,000 people in America, it figures there must be someone who has the experience and skill set to reliably solve the health insurance and access problems besetting our country without throwing away the most excellent and caring medical system in the world.

Recently, when an old friend, a seasoned educator, and I, a seasoned physician, got together on a vacation in Colorado, he asked me if I had a simple solution for the medical insurance and access problems on the front pages of America's newspapers.

I told him "Yes, I do," but that it is so simple and inexpensive, without taxes or cuts in medical quality, that no one would believe me. It was he who insisted I put pen to paper because he felt there was an audience for a common sense solution to the health care ailments of America.

So here is the distillation of my 40 years' observation.

First, we should change the current 50 state patchwork of private insurance programs -- which cannot cross state borders -- to a national clearinghouse of private insurance choices that can compete across the whole country. Meanwhile, we should regulate the competing companies so that they must take all comers, regardless of pre-existing conditions.

Secondly, we should return health care insurance companies to the pre-1984 federal regulations that limited their fees to administration only (about 15% of medical dollars), without excessive profits going to their boards of directors, CEO's or shareholders. The provision of medical care is not the type of profession that can be treated as a simple commodity. The corporatization of health care was a bad idea, and it's getting worse. It has contributed tremendously to the crisis we're in now where hospitals and doctors feel squeezed -- forcing some of them to shut their doors or quit -- while insurance company profits soar.

Third, we need to make health insurance plans completely portable for individuals with life changes, in order for the insurance companies to compete on a flat playing field for the whole U.S. population. Ideally we should move away from employment-based health care. If employers do not have to pay the soaring costs of healthcare for their employees, they can raise their employees' salaries in a commensurate manner, and the employees, in turn, can choose which level of health care plan they want to purchase.

Of course, people who can afford it should be required to purchase health insurance, in the same way that we are required to purchase car insurance, but they would have the choice of which plan to purchase.

And last, the health care overhaul should include meaningful tort reform that caps frivolous malpractice suits. Such a policy has seen great success in California for 34 years.

With the four above changes, competition across the whole country should prompt health insurance companies to improve efficiency and cost-effectiveness (similar to what GEICO has done in the car insurance arena). Notice that the government has not had to spend significantly or nationalize health care to accomplish this. All that is needed is thoughtful insurance company regulation, and the mandatory participation of all citizens who can afford what will be competition-driven reduced premium costs.

But what about the indigent and illegal alien populations who still need access to good medical care? How do you take care of them without an extra tax burden on the working population? This is easy for me to envision because I did it for decades via the model of our USC/Los Angeles County Medical Center -- the busiest teaching hospital in the United States.

"County USC" handles hundreds of thousands of clinic visits by indigent and illegal alien patients every year, allowing for wonderful experience for our doctors-in-training under the guidance of a great faculty. Because our hospital has 2000 penetrating-wound (knife or gunshot) patients per year, the U.S. military rotates its trauma surgeons here for 6 months at a U.S. Naval sub-station, before deploying them to Iraq and Afghanistan.

Thus, the final no new-tax solution to the health care problem is to get all of the urban medical schools back to serving their local indigent populations, with a standing "open door" policy, and no dumping of those patients off to other private hospitals or clinics while still obtaining Federal Grants (such a dumping policy was recently disclosed to have taken place at the University of Chicago Medical School).

If the large urban medical schools remember that "school" is in their name, they will use the teaching environment to promote great care as we've done for over 100 years at County USC. Also, in carrying out this primary teaching function, the schools could be subsidized (as has been done for decades by Federal, state and county funds), but with the money going directly to the delivery of medical care, rather than the expansion of bricks and mortar.

Great American-style medical care can be provided cost-effectively in simple perk-free settings, as in the U.S. military hospitals, without requiring the private rooms and flat screen TV's for every patient that have contributed to bankrupting many hospitals.

Federal regulations and mandates of all U.S. medical schools to emulate the County USC model would address the load of indigent patients and give our medical schools back the patient experience they sorely need for continued training of our physicians.

This plan represents my simple solution to preserving all of the best aspects of choice and quality and access in the American medical system, without the need for new taxes at all. Nor does it require nationalizing under a government-run plan, which is guaranteed to increase bureaucracy as well as the delay of essential medical services, such as seeing a specialist, undergoing surgery, or obtaining cancer treatments.

And an added plus is that our medical schools can get back to their teaching mission as best exemplified by the County USC model, while providing great training for our future doctors.


With thanks and acknowledgement to Beverly, my high school sweetheart and wife, for 44 years of understanding support of my career, and to my friend, Bill Habermehl, for his inspiration in helping me to save "American-style" medicine.