A Common-Sense Plan to Improve American Health Care Delivery
This thesis proposes an affordable system of personal health care characteristic of American justice and free enterprise. Our health care should be the best in the world. We have the best hospitals and universities, but our care is less comprehensive, less efficient, and more expensive than in any other industrialized nation.
The Affordable Care Act has not met our country’s needs, and it is highly unlikely to do so. With incidental adjustments, we may make little or no progress. Alternatively, we can plan a series of incremental changes over time that will lead to a health-care system that represents America at its best.
To test whether our best is conceivable, we convened four retired physicians of diverse expertise and a retired regulator/judge to foresee what might be best for America. The ease with which we agreed surprised us.
We agreed that:
- A strong, free, and competitive nation must provide at least a minimum of disease prevention and treatment to all its citizens, including its poorest.
- Prevention and care must be portable, not limited by residence or employment.
- Scientific panels, subject to appeals, can distinguish between care that is necessary and effective to prevent disease and prolong life (BASIC care), and care that may be desirable to some people but is not a compelling use of tax support by all (SUPPLEMENTAL care).
- Basic care’s cost should be assessed as premiums paid by or on behalf of all citizens. Those unable to pay would have premiums paid from the federal government’s general revenues to the Department of Health and Human Services (HHS). Those who are able would pay premiums needed by HHS to provide BASIC services and would do so either out of pocket or through their employers. HHS would pay providers the fees allowable for BASIC necessary services.
- Supplemental care costs would be paid voluntarily by those able and willing to do so, either out of pocket to providers, or as premiums to private, minimally regulated health insurance companies. Insurance companies would advertise menus of policies providing desirable but non-essential benefits, such as fast and direct access to specialists of choice, luxury accommodations, and providers of alternative care. Procedures too controversial for acceptance as basic care might be covered as supplements with charity support for citizens unable to pay.Insurers would pay doctors, hospitals, etc. for chosen benefits not covered by the BASIC plan. Consumers would purchase such benefits at their own risk.