I asked the most intelligent medical doctor in the country, Doctor Sam Metz, what he observed can be done. Here is his practical, necessary, and cost-effective plan:
You asked this question of the right person or the wrong person, depending on your political bent and time available for an answer. Attached are essays that appeared in the Oregonian and in Anesthesiology News, and a PowerPoint presentation to be given next month. I will condense everything you need to know about health care reform into three questions, with three answers each. Once these points are understood, much else will make sense.
1. Why does this country need health care reform?
Americans pay twice as much per capita as the average industrialized country.
Our public health results (maternal mortality, infant mortality, life expectancy, lives lost to preventable conditions) are among the worst of industrialized countries.
We are the only industrialized country in which non-wealthy citizens lose their homes or lives if they have insufficient money to pay for needed health care.
2. What must legislation achieve to be considered health care reform?
It must provide universal access to primary care regardless of health, wealth, or employment.
It must lower health care costs for everyone, not just the government, the wealthy, or the insurable.
Our national public health must improve.
3. How do all other industrialized countries provide universal health care at lower cost with better results?
All citizens are in a single risk pool with the same set of benefits.
There are no impediments to primary care.
Financing of health care is done by not-for-profit agencies. Profit can be made providing health care, but not financing health care.
If a country follows all these rules (as most every other industrialized country does), universal health care can be achieved at lower cost with better results then we have now. If the country follows all these rules and uses a single not-for-profit financing agency rather than multiple financing agencies, this is called “Single payer health care.”
I favor single payer financing of health care.
However, changing how we finance health care is only the start. The next step is revising which health care providers we pay how much for what services under what conditions for which patients. The incentive for salaried physicians is to undertreat. The incentive for fee-for-service physicians is to overtreat. Under capitated payments, the provider takes the risk if a condition is more expensive to treat than expected. Under salaried or fee-for service payments, the financing agency takes the risk.
That should be fun.
If you still have questions, I am full of answers.
Thanks for asking.