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The 15-Point Solution to the Health Care Crisis

Why This Problem Is Now a Crisis

• Increase costs to the individual. We've all felt the hit from increased monthly premiums, higher deductibles, higher co-pays, and so on. The increase in costs over the past few years have in effect wiped out any employment raises. Health costs will soon surpass housing as our biggest monthly expense. Between premiums, deductibles, and co-pays, an individuals can end up paying several thousands of dollars before insurance kicks in dollar one. Things will only get worse as the population ages.
  
  
• Increase costs to businesses. Most employees don't realize that the insurance premiums deducted from their checks are only part of the monthly insurance cost. The businesses providing the plan often shoulder a much bigger burden. When health costs go up, less money is available for raises, new hires, and profits. In other words, stock values of our 401(k)'s are affected by shrinking profits and businesses are less able to hire new employees. Many of the smaller businesses, especially the service-oriented ones, are forced into bankruptcy.
  
  
• Tens of millions of uninsured Americans. The number of uninsured Americans is already over 35 million, and it's growing at an exponential rate. More and more people, if they can afford insurance at all, are finding it's easier to go without insurance than pay the exploding costs. When a person doesn't have insurance, he's less likely to seek medical help when problems arise. Thus, prevention costs as well as the modest cost of catching certain problems in the early stages lead to the much greater costs of full-blown illnesses & diseases. The costs of these full-blown problems must be absorbed by all the insured individuals.
  
  
• Longer wait times and less access to health care. Have you ever gone to a doctor's office and been seen by your physician within 5 minutes? Times vary, but it's not unusual or unexpected to wait 30-60 minutes after your appointment time before being serviced. Depending on specialty, it may take weeks or months to even get an appointment. It's rarely the fault of the medical professionals. They are simply too overworked and understaffed. Beyond the inconvenience, this contributes to lost productivity of the entire nation.
  
  
• Businesses pass on costs as higher consumer prices. Health insurance is simply another component of labor costs. Just like costs of energy, equipment, and rent are factored into the cost of a product, so are labor costs. To ensure a profit at a level that makes it worthwhile to stay in business, companies must raise prices. Thus, rising health costs lead to inflation throughout the economy.
  
  
• Economy is hit by redirection of consumer spending. Since consumers must spend a larger percentage of every dollar on health care, less money is available to buy cars, computers, clothes, and other items that fuel a thriving economy. Rising health care costs could easily throw us back into a recession.
  
  
• Unhealthy individuals may have trouble finding employment. A sad fact of the current system is that monthly premiums are determined by the cost of your insurance pool. In the same way that you're charged higher auto insurance premiums when you have multiple accidents, a poor health record can increase the costs for everyone in the pool. For example, if you have one employee in a pool of 50 people that gets cancer or some other expensive illness, everyone in the 50 must absorb higher premiums. Although it's technically illegal to make hiring decisions based on health conditions, some businesses may find other reasons not to hire a potentially expensive individual. In fact, for small businesses on the edge of financial ruin, there may be no choice.
  
  
• National & worldwide shortage of doctors, nurses, and other health professionals. Hospitals simply cannot keep up with the rising demand for health care. There's obviously a shortage of medical professionals or you wouldn't be forced to wait for appointments, and salaries wouldn't be so high. This is more than an American problem since the high salaries are pulling professionals to the U.S. from India, Britain, Canada, and other areas around the world. We have a shortage in America despite the most advanced medical training system in the world; you can imagine the shortage in 3rd world countries such as those in Africa or South America.
  
  

A 15-Point Solution

1. De-regulate the medical profession. It's time the government ease restrictions on who can do what in medicine. Does it make sense that someone who wants to perform heart surgery has to go through the same amount of education as someone who wants to set broken bones and prescribe infection remedies? Does it make sense that 3rd-year med students are allowed to perform medical tasks that a nurse with 30 years of experience can't? Does it make sense that a Ph.D. psychologist can't prescribe Zoloft or Prozac but a psychiatrist who can prescribe the drugs must go through 8 years of education almost completed unrelated to psychology? Medicine is probably the most complex subject in existence; still, the vast majority of medical tasks don't require someone with 12 years of tortuous training. Health care costs are so high because tasks that could often be performed by nurses, physicians assistants, paramedics, and CNA's are restricted to fully-licensed doctors. De-regulation would reduce costs in three ways: 1) Routine tasks can be billed out at the much cheaper rate of the non-doctor; 2) Doctor salaries would fall since they wouldn't have to handle the same case load and pressures; and 3) Competition would increase, which always leads to lower prices and better quality. Doctors would also have more time to devote to the tougher cases, and you'd draw more students to medicine since they'd be able to do more meaningful work without having to devote the time and money of becoming a full physician.
   
   Why, in a nation of 280 million people do we have only 600,000 doctors? There are millions of potential students out there who have the intelligence to do the work but can't go all the way through med school because of financial, work, or family obligations. Or maybe they're part of the 95 percent of applicants that are denied entrance to medical school because of rigorous requirements and few open admission spots. Yes, we want and need an elite class of physicians, but given the dire situation, maybe we need to open certain tasks to lesser-trained individuals.
   
   Some may worry that this opens the door to more medical mistakes. Yes, lesser-trained individuals will make more mistakes, but remember, people have a choice. If they want to save some money and possibly take a little more risk (which may be more perception than reality), they'll choose a nurse or other lesser-trained individual. If it's a more complex problem, they'll go to a fully-licensed physician. Think about how many doctors refer their patients to specialists anyway. What difference does it make if the first cog in the machinery is a nurse? Also remember that a medical professional always has the threat of a lawsuit if he or she screws up.
   
   
2. Create a range of new medical training levels and specialties. Despite the vast number of medical problems, there are very few specialties. Sure, there are specialties, but they're all at the doctor level. It takes almost a superhuman to get through the rigorous training requirements we have for our physicians. Each student must spend an average of $150,000 and devote 8 years to a grueling education program. Then, he or she must complete a slave-labor 4-year residency with 80+ hour workweeks. This is just to start their medical career. Almost anyone in medicine will agree that while a solid base of knowledge is important, you don't really know what you're doing until you've accumulated years working on real cases. Think about it. If you had a certain medical problem, would you rather see someone with 12 years of general education and no expertise in your problem area, or would you rather see someone with 12 years of experience working specifically in the area you need help?
   
   I'm suggesting that in addition to de-regulation, we develop several new specialties and education levels. Obviously, to work in medicine, you'd want to require a base set of classes in anatomy, chemistry, biology, etc. But after that, training can be ultra focused to areas of specialty. Students could be given hands-on and written certification tests at multiple levels to demonstrate their ability in their area. We could have several levels of doctors or nurses. Think about how achievement in martial arts is structured. You start out at white belt and proceed through various colors all the way to black belt. To advance to each new level, you must devote a certain amount of time and demonstrate a certain set of skills. By looking at the color of belt, we instantly can guess a person's ability and level of training. Think about the financial planning profession.  A 2 or 4-year degree may get a professional his or her first job, but customers may not want to go to that person unless he or she has CPA, stock broker license, Certified Financial Planner qualification, etc. Now consider how doctors are currently ranked: there's really only one level: DOCTOR! 
   
   Again, it's all about choice. We still need the heavily-trained individuals for the complex cases. We can save money by going to a lesser-trained, lesser-experienced individual if we want. Insurance companies could offer incentives to use the cheaper alternatives. For example, go to a nurse for your physical and it doesn't count towards your deductible.
   
   One last idea when it comes to specialties: allow the creation of businesses that specialize in performing certain types of tests; for example, CT scans, X-rays, etc. Businesses could be set up to do nothing but the type of test that's required. A specialist could streamline operations and squeeze out levels of efficiency like never before. Once again, regulation constrains true reform.
   
   
3. Develop a new no-patent government drug research & development facility (or contract with a private firm). Prescription drugs are undoubtedly one of the most expensive components of rising health care costs. However, the actual production of drugs is usually pretty cheap. The expense comes from the research and development. Remember, creating new drugs can take years or even decades of meticulous, expensive research & testing. And for every successful new drug, there are hundreds that turn out to be a waste of time. Drug companies must charge exorbitant prices to recoup their costs and ensure an adequate profit. Unfortunately, because patent laws create a virtual monopoly on their product for 17 years, they can charge whatever they want (subject to market price demand). I'm proposing the government start a not-for-profit drug research facility where patents laws aren't applied and all experimental learning is shared with the public. There are several advantages of such a facility.
   
   First of all, once a drug is created and approved, anyone would immediately be allowed to make and sell it. Competition would drive the price to rock bottom levels. Second of all, time could be devoted to curing illnesses and diseases that aren't always the most profitable. For example, certain types of fevers such as malaria are almost non-existent in the U.S., but are major problems overseas. We could develop remedies that were never dreamed of, possibly prompting other countries to do the same. Lastly, we will be able to build the knowledge base for everyone, leading to the faster develop of new life and pain-saving drugs. In the current system, drug companies almost have an incentive not to share their knowledge since doing so might lead to other companies gaining a patent first. In a government-controlled facility, we could, for example, require the results of certain experiments be posted online.
   
   
4. Create a new statute to punish those who bring frivolous malpractice suits and extort money from doctors. Frivolous lawsuits against doctors and hospitals, especially ones with outrageous verdicts, have led to skyrocketing medical liability insurance. Many lawyers will extort money by threatening lawsuits, even though they have no chance of winning. Doctors may opt for a quick settlement anyway since the cost of a malpractice lawsuit is enormous compared to paying the lawyer to just go away. A solution to this is to get back at the lawyers responsible for attacking the doctors or hospitals that haven't done anything wrong. What I suggest is a new law that requires that not only should the plaintiff have to pay court & attorney fees to innocent defendants, but lawyers who encourage the case be forced to pay a matching amount as a fine. The lawyer would also lose "points" on his legal license, so those with a track record of bringing frivolous lawsuits would lose their license to practice law. 
   
   
5. Develop a new court system to deal with medical malpractice lawsuits. Medical malpractice lawsuits are by far the most expensive to bring to trial. This makes sense when you consider the subject matter of the trials involves doctors who go to school for 8 grueling years, endure 4 years of 80-hr week residency, and then work several years on their specialty. Can we really expect a jury of 12 people who have little or no medical training to understand what's going on? Not only is it expensive, but too often juries who don't understand the facts must pick between a rich doctor and a feeble, dying, or disfigured patient. So even if the doctor has done nothing wrong, he or she may get the shaft. And that cost is of course passed down to us in increased health insurance premiums. I propose setting up a specialty court system similar to what we have for tax and bankruptcy disputes. Decisions would be made by trained medical professionals who can better understand the issues and render fairer verdicts.
   
   
6. Create liability caps on damages for pain & suffering and punitive damages in malpractice lawsuits. Doctors across America are walking off the job or giving up their practice because of the exorbitant cost of malpractice insurance. Malpractice insurance is passed on to all of us in higher insurance premiums. There should be no limit to damages for lost income or medical bills caused by malpractice since they can be objectively measured. However, pain/suffering and punitive damages are intangible amounts that need to be reined in. Juries often come back with unjust awards because they feel sympathy for the patient and figure a rich doctor or insurance company can afford the loss. Everyone makes mistakes, and doctors should be held accountable, but excessive lawsuits are changing the medical system as we know it. Doctors are practicing expensive defensive medicine to avoid getting sued as well as curbing or eliminating risky areas of practice. Remember, there are plenty of punishment options for doctors that screw up that don't involve money; for example, suspension or revocation of their license to practice. This solves both problems: getting the poor-performing doctor out of the profession while keeping our health insurance premiums from going up. A $250,000 or $500,000 cap on damages would be a reasonable start in addressing all these problems.
   
   
7. Build a series of lawsuit-prohibited medical facilities. If you could save thousands of dollars by going to a doctor with the same expertise as other clinics but for which there was no chance to sue if a mistake was made, would you go? Some people would say yes; some would say no. There's always the chance you'd get lesser quality because the threat of lawsuit isn't there to keep up the pressure; however, you may get better care since doctors can concentrate on curing the patient rather than covering their butts. I suggest clinics be set up where patients must sign a release preventing any legal action if they want to be treated. Doctors would be able to charge a small fraction of what they currently do since they wouldn't need to pay hundreds of thousands in malpractice insurance. You'd also be able to save money arising from unnecessary tests that are often carried out to minimize legal liability.
   
   Remember, people are required to sign do-not-sue releases to go bungee jumping, sky dive, take a karate class, and do a number of other activities. Does this stop people from going? People will come to such a medical facility often because they have nowhere else to go or because they're not worried about malpractice when getting an antibiotic prescription. Is such a facility an unrealistic idea? Not by a long shot. Patch Adams, the doctor on whom a movie was based, founded a free clinic called the Gesundheit Institute and ran the clinic without malpractice insurance. He has since expanded and introduced all kinds of revolutionary medical ideas. Thousands of doctors have volunteered their time to his program. It's not realistic to operate all free clinics, but the costs of a clinic that doesn't need malpractice insurance is dramatically cheaper.
   
   
8. Streamline or eliminate the FDA, and de-regulate the process of approving drugs. While the FDA's purpose of protecting the public is noble, the organization has become increasing less useful and is causing more problems than it solves. It was originally set up to protect the public from charlatans selling snake oil and other potions, but in today's complex pharmaceutical market, the organization isn't as necessary.
   
   Consider the problems caused by the FDA: 1) The FDA costs the taxpayers an enormous amount of money to function; we should always be looking for ways to cut government waste so the funds can be redirected to other areas. 2) The FDA delays the release of drugs, causing pain and death in patients. Like all government offices, bureaucracy slows operations to a crawl. It can take months or years to get a new drug through the screening process, even though the seller has already screened the drug thoroughly. For patients who are suffering and those who will die without a new drug, this delay is unacceptable. The FDA will bring criminal procedures against the seller even when the patient is willing to assume all risks. 3) The FDA drives up the cost of prescription drugs. The impractical requirements placed on drug makers along with the added layer of screening forces companies to charge more for their products.
   
   Some may ask "What about the consumer? Won't this increase the chances of unsafe drugs being put on the market?" The answer is a possible yes, but only marginally so. Remember, drug companies are worried about their reputation and don't want to be sued. One class-action lawsuit or the bad press of one unsafe drug could put them out of business. Thus, they take great pains to make sure their drugs are safe. And drug companies are run by human beings who obviously don't want their products to cause harm. The FDA just adds a repetitive layer that isn't necessary. Patients and the doctors from whom they get a prescription are going to factor safety into their decision to use a drug. Thus, even without the FDA, it's likely a private screening company will develop to certify the drugs. Private policing of the industry is faster, cheaper, and more flexible. It's time to cut some of the FDA fat from the budget.
   
   
9. Streamline the process of purchasing drugs for consumers. I went to the drug store last week to pick up some asthma meds. Despite the fact that I called a day ahead, I had to wait 45 minutes for my prescription. Why? Because I had to have a pharmacist explain to me how to use an inhaler I've been using regularly for over 15 years. Have you ever gone to pick up a prescription and not been subjected to a wait in line? The cost of pharmacy employees is part of the drug distribution cost. Wait times are ridiculous because overprotective, condescending politicians have passed laws forcing pharmacists to read you a label that says "Take this twice per day with meals." After all, it's possible you can't read or didn't hear when your doctor told you the same thing the day before. The average hourly cost of a pharmacist is over $65. Multiply the hours you'd save by the number of pharmacists in the country.
   
   
10. Pass a law requiring publication of price lists of all medical services. Did you ever stop to think that medicine is the only business that doesn't publicize it's prices? Can you imagine dropping your car off for repairs and having the mechanic pick any price he deems appropriate? Publication of prices leads to more-informed consumers. Consumers would be able to shop around for better prices and question unreasonable fees.
    
    
11. Set up a new scholarship/grant program for those that want to enter the health profession. The average medical student graduates with over $100,000 in debt. Then he or she must work a 4-year residency at close to minimum wage. Is it any wonder that few doctors want to volunteer time or work in low-cost clinics? Is it any wonder they try to squeeze in as many revenue-generating patients per day? They have to just to pay school loans, malpractice insurance, and other overhead! The nursing shortage gets worse every year, which leads to longer hours for the current staff and more potential for costly mistakes. We should be doing everything we can to get more students into the medical profession. The economic laws of supply show prices will drop proportionately, so the scholarships should pay for themselves.
    
    
12. Increase awareness of WebMD, Ask-a-Nurse, and other free medical advice. There is an endless wealth of free information on the Web and on phone hotlines that people simply don't know about. Most minor problems could be solved by the patient if he or she took the time to look up the ailment. Part of the problem is that people don't know you can get diagnoses, symptoms, causes, related illnesses, etc. without paying a dime. Most of these medical data banks will have a section "When you should visit a professional", so the basic problems can be solved with minimal risk.
    
    
13. Develop a national health information system that centralizes all medical information. Did you realize that 60-70 percent of your medical dollar goes towards administration and insurance costs? How many times in your life have you filled out a full medical history? How many times have you had to re-explain your medical background to a new doctor? Every medical office has its own set of medical records that must be organized, filed, data-entered, and maintained. Every medical office must duplicate insurance information, organize claim procedures, and manage their own computer system. This redundancy causes two major problems: 1) It creates a greater chance for error, by both the patient and the hospital staff; 2) It doubles the administration costs which are passed on to all of us as higher premiums. Think about how much money we could save in the future if we integrated all this health information into one national database. Consider how much better doctors could do their job if they could pull up a full medical history of the patient's treatment, including treatment at other hospitals.
    
    
14. Ease right-to-die rules. By far the biggest advantages to physician-assisted suicide are the preservation of dignity, minimization of suffering, and the easing of anguish on family members. These cannot be underestimated. It's almost callous to think it, but there's another advantage that most people don't consider, which is the savings of health care costs and freeing up of hospital staff resources. Money and hospital staff time mean nothing compared to human life, but for a person who wants to die and faces a certain painful death, wouldn't it make more sense to re-direct money and hospital resources to patients that can be saved and want to live? For example, does it make sense to spend tens of thousands of dollars keeping a suffering bone cancer patient alive to the last excruciating breath while occupying the time of a doctor, nurse, and CNA--all when the patient wants to die gracefully? Savable patients suffer and die every day because of hospital understaffing. We need to be smart and practical if we are to achieve maximum benefit for society.
    
    
15. Design new insurance plans that shift more costs from premiums to out-of-pocket costs. Perhaps the biggest reason why health care costs are out of control is that the economic laws of supply and demand have been removed from the industry. I've already talked about how stifling government regulation has limited the supply of medical resources; now, let's consider demand. The U.S. has the most diverse and advanced access to medical care of any country in the world. Consequently, we've become a bit spoiled. We've developed an entitlement mentality in this country. We feel we are entitled to the best medical care regardless of expense, and we think we should have to pay little or nothing for it. Unfortunately, the best technology, the best trained professionals, and the best prescription drugs cost money. If we were forced to pay out-of-pocket for all our medical care, we would be a little more frugal. We would discipline ourselves and modify our habits--Do I really need this CT scan? Should I run to the doctor every time my child sniffles? Do I need a doctor with 20 years experience to perform some routine surgery or would a new graduate be able to do it just as well? Do I need the latest and greatest surgical equipment or would the cheaper conventional equipment do the job? Should I go to the doctor for some antibiotics to cure this problem immediately or should I let my body fight it off?
    
    Imagine if we had the same entitlement mentality with housing. After all, housing is a basic need that all Americans must have for survival. Imagine you had a $5000 annual deductible, but after that all your housing costs were paid for by insurance. Would you choose a small basic apartment that costs $5200 per year or would you go for a $15,000 penthouse with swimming pool, hot tub, and fire place? Would you like a small townhouse by the airport or a 100,000 square foot beach house?
    
    The whole purpose of insurance is to spread the risk and costs of unusual and unexpected events. It was never designed to pay expenses from your daily lives. Health insurance premiums should be reduced to the same rate range as life insurance premiums and cover only the major medical problems costing, say $10,000 or more. Currently between business and individual contributions, $3500 is paid out on average per person every year before insurance starts to help out. Then you have to deal with co-pays and other costs. An out-of-pocket focused plan would mean that $3500 normally spent on premiums would be available to the consumer. For years where patients have no medical problems, the money could be pocketed. Obviously, people will be much more frugal shoppers. They will go only when they really need to and will demand better value for their money. Thus, economic laws of supply and demand would go back into health care, lowering prices to the point that $3500 per year will easily take care of almost all individuals. Remember that 60-70 percent of each health care dollar is spent on administration costs. An out-of-pocket focused plan would mean hospitals could eliminate the tedious insurance claim process for most of their charges.
    
    There are secondary benefits to such a shift in cost. If people are forced to pay more out-of-pocket for all health care, they're more likely to exercise, eat right, and practice preventive medicine, all of which are vastly cheaper in the long run. It's all about personal responsibility. We'd shift the focus of our society away from the pill-popping solution to every medical problem, which is counter-productive and causes a host of new problems. For example, overuse of antibiotics has led to the breeding of new superbugs. In other words, infections that used to be easily cured with antibiotics have grown resistant and now cannot be fought at all. The human body was built for one thing--survival. It can fight off most health problems if we simply let it.
    
    

Conclusion

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