Guest editorial: Solutions for providing fiscally responsible health care

Solutions for providing fiscally responsible health care
by Kline Bolton, MD

Health Care Providers, patients, and others in the health care system agree that the system is broken.  The current Health Care Bill has many new features.  It offers unlimited benefits, access for all citizens and immigrants, legal or illegal, equal access regardless of preexisting conditions, non-refusal by insurance companies  for any cause, elimination of co pays and deductibles, and many other benefits. But there is no free lunch. Someone has to pay for these additional benefits. We will all have to pay. The bill will add  trillions to our deficit, placing a financial burden on our children and their  children for generations to come, and does not sufficiently address access to care.  The biggest issue is how to make health care available to all citizens, yet decrease cost, debt, and improve care. The following solutions were proposed to various members of Congress, but were ignored.  Implementation of these steps can accomplish these goals.

1. Tort reform- institute malpractice caps, malpractice panels, and have losers pay the cost of frivolous suits.  The result will be lower health care resource utilization.
2. Remove geographic restrictions to competition between commercial insurers and allow individuals to take their insurance with them, where ever they go. Competition traditionally drives down price.
3. 1% surcharge on all premiums to fund indigent patients.
4. 1% surcharge on premiums to fund clinical and basic health care research to improve care and decrease cost.
5. Decrease taxes on small businesses to foster expansion, hiring more staff and paying more healthcare premiums.
6. Incentives to businesses to pay insurance premiums for employees.
7. Decrease taxes with a percentage to go toward indigent patient premiums.
8. Insure only US citizens.
9. Simplify and cut administrative and regulatory work to half, that is, decrease administration to 20% from 40% and apply the savings to health care reform.
10. Allow physician panels and care givers with patients and uninvolved physicians to make medical decisions without the risk of lawsuits, not administrators and business people.
11. Require public service of those receiving discounted or free medical dollars to off set some of the societal costs.
12. Reward facilities and providers for better outcomes.
13. Reward patients for health promoting life styles with points leading to lower premiums or other rewards.
14. Develop Health Insurance accounts- leads to  individual patient “skin in the game” and attention to their own health care
15. Make access to healthcare insurance the same for everyone-the indigent, the employed and unemployed, congress, the Supreme Court, and the President.
16. Revise EMTALA legislation to correct expensive abuse of Emergency Services.
17. Train and utilize RNs and pharmacists, with nurse practitioners and physician assistants, under the direction of physicians broaden  focused health care, especially wellness and disease prevention.
18. Develop internet based limited self-care and patient empowerment with validated algorithms and protocols.
19. Increase the number of doctors by making available “Health Professional Student Loans” for interested students.
20. Risk stratify to recognize individual responsibility, just like auto and life insurance policies.
21. Implement fraud and abuse oversight to decrease cost.

These are solutions promulgated in the cold hard light of reality, without genuflection to attorneys or physicians, insurance companies, or the government. We can decrease cost, decrease the deficit, improve the quality of care, and provide health care for our citizens. To do so requires all of us to “think outside the box” and consider the essential elements of self control, individual responsibility, adherence to the law and the constitution, and abandonment of  political/party constraints.  Implementation of these steps can deliver to the American people the health care they want. But it will take new thinking, participation by all, and a type of flexibility across the aisle not seen for decades.