Could not agree more!
We can indeed create a healthcare system that works! It will take some innovative thinking, some compromises, and some determination. First, we have to recognize that the free market system does NOT work in healthcare, and that the current “system” is on the verge of collapse.
Philosophically, we have to answer three primary questions that will require a sustained public debate.
1) Is healthcare a right or a privilege? As it stands now, it’s a privilege until it becomes life threatening.
2) Do we want a healthcare system that chases the last red corpuscle around, or do we want a system that truly empowers the quality of life as much as mere existence.
3) Are we, as a public, passive recipients of healthcare, or are we active participants in demanding healthy environments and striving for healthy lives?
Structural changes must deal with four main areas, access, the practice of medicine, secondary and tertiary system administration, and financing. By opening the front doors of access, we can entrain more people into the system. I have yet to understand the obstinate refusal on the part of the State Medical Associations in allowing ARNP’s to practice independently with prescriptive authority. The studies are OVERWHELMING in support of this. 42 States have allowed independent practice, and 10 prescriptive authority, and not one of these states have suffered ill consequences. Given the growing shortage of primary care physicians, this selfish position is completely illogical. The key to long term health is getting more and more people (especially women) into the healthcare process.
Women are the key determinants of the health status and relationship of the family to the health care system. Nurse practitioners are well grounded in providing health care and health education to underserved populations, especially women, often with innovative and out-of-the-box- solutions.
The practice of medicine has to be changed. We need to create a community based physician/primary care provider system which is rewarded for keeping patients out of the high cost medical centers, and a medical center physican/provider core which is NOT rewarded for keeping people IN the hospital.
We should do away with payments for providers in the secondary and tertiary systems and make them employees, working regular shifts and providing care/interventions/diagnostics around the clock.
Trying to cram an around the clock care system into a 9-5 business model is inefficient and wasteful. Malpractice rates can be adjusted based on the performance of the entire medical staff, thus creating an empowered peer review process which would demand excellence.
We need also to look at how the healthcare system is administered. If we want to create true community based healthcare systems, then we need to restructure that system. Each secondary/tertiary hospital would be assigned a geographic area, and then made accountable for the delivery of services. Nursing homes, rehab facilities, and even home health services would fall under the control of the community system, doing away with the compartmentalized for-profit entities.
Thus, significant corporate/administrative savings would be evident as well as retention of profits into the not-for-profit community system. No more stockholders, no more corporate overhead, no more wasteful bribery to physicians for services. I believe this system should be put under the control of nursing in order to balance out the ethical forces. Yes, CFO’s would still be needed for financial direction, but we could focus on services with both long term and short term benefits. It would amount to a social contract with nursing, and we could then hold them responsible for results.
The financing of this system is also important. Physicians deserve to get paid for services, no one argues that. They also need protection from exorbitant malpractice and/or pity awards. The community system will need stand-by revenues as well as operational reimbursement.
We can do all this with the revenue we have, since we currently spend between 30 and 40% in administrative fees and around 25% in the last two weeks of life. An actualized healthcare system can begin to significantly reduce this.
In terms of taxes, we now tax cigarettes (#2 cause of morbidity) and alcohol (#3 cause of morbidity) but not the #1 cause, junk and fatty foods. This tax alone would generate enough revenue to fund Medicaid in every State and have enough left over to activate a true public health force.
Vital systems within the health care system should not be paying for utilities or utility system service. Consider this the public contribution, since we will in all possibility be able to eliminate all or at least a significant portion of the county and state homeowners tax in thos districts currently paying for health care!
Now we have to ask ourselves if we have the legal/social power to do all this? YES. In 1935, Congress enacted the PUHCA (Public Utility Holding Corporation Act) legislation, essentially taking over the access, distribution, and cost of (primarily) electricity. This is the model we have to look at. After all, health care and health education serve us all in the long run. We can do all this, but it will require talking to each other, compromise, and the generation of political will. Let’s talk!
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Most common myths about the American Health Care System -> debunked!
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