Common Sense Approach to Healthcare

The current debate on healthcare has become ideological and not helpful. Let us set some guidelines and find a solution.
     First: Focus on the uninsured. Not the 47 million bantered around in the press, but the actual uninsured that need healthcare. That number is more in the 10 million range. The goal should be to provide quality care and keep a patient from being forced into dire financial straits.
     Second: Don’t force anyone to buy insurance. If based on means, the citizen can afford the services or has insurance, that citizen or the insurance should pay for the service. If the citizen is unable to pay, then this proposal will support that uninsured citizen.
     Third: Keep the decision-making in the hands of the doctors and hospitals.
     Fourth: Don’t try to solve all aspects of the problem. Start with the labor portion. In other words, let’s make sure quality healthcare professionals are available to treat those needing attention. If the government solves all aspects (labor, materials, medicine) then this opens the door to more abuse and the possibility patients will drop private insurance for the ease of the government plan.
     Fifth: Since the government is getting involved, let’s only trust the government to manage something that it has proven to be able to do successfully.

Proposal: Provide education and training for Health Service Professionals (HSP) that utilizes already existing medical schools and programs. These resources will have their tuition paid for while in school in return for a pre-determined commitment to serve on government salary.

     Given the above guidance, this proposal starts with the fourth and fifth axioms. Don’t try to solve everything. Focus on the labor costs with the goal of providing services for those that need it. From the fifth axiom, we need to ask, “Where has the government ever proven itself to successfully manage a complex issue?” The answer is found in the defense of the country. More specifically, the leadership and training of the men and women serving in the armed forces is nothing short of a huge success story for this country. ROTC, Academy and myriad enlisted training programs have produced the world’s #1 military. This model can be used to generate a government salaried healthcare workforce. At a minimum, the government has a successful history of managing this type of endeavor.

How many HSPs are needed? Studies will need to be done, but roughly speaking in order to cover 10 million of 300 million Americans, approximately 3-5% of the healthcare workforce will need to be part of this plan.
Is this program only for Doctors and Surgeons? No, any healthcare requirement will need a certain percentage of HSP employees. There will be a different pre-determined commitment period based on what field was paid for by the government.  Physical Therapy, Radiology, Occupational Therapy, etc... all need HSPs.
Who gets to be a part of this program? It will be competitively decided similar to applying to a university for acceptance. Applicants from all over the country will be desired. This will mitigate issues with assigning personnel to remote locations after graduation. A component of the plan will include HSPs agreeing to be assigned to locations in the United States most in need of their services during their commitment period.
The competitive nature of this plan also insures a high quality of service to uninsured Americans. The best and the brightest will be drawn to this program and they will deliver quality service upon graduation.
Who manages the health service professional? The personnel will indistinguishable from any other private practice professional. Health service professionals can work for hospitals, private practice, group practice or any other health provider. All issues on case load and decisions will be between the doctor and the patient. There will be no government intervention on what services are provided and to who they are provided.
Who pays the salary of the health service professional? The government will pay the salary of the health service professional. The salary during the commitment period will be less than the prevailing market rate and will be paid by the government. None of the HSP labor can be billed to the patient or the insurance company.
Can the HSP treat insured patients? Yes, this aspect of the plan will reduce healthcare costs to the insurance company and subsequently to the insured population of patients. Thus, there is a direct benefit to taxpaying and insurance covered American citizens. The HSP can and should also be used to treat Medicare and Medicaid patients. This will lower the costs of those programs to the government, too.
What if there are more uninsured patients than can be handled by the resident HSPs? The program will self-regulate by assigning needed HSPs to areas with high demand for the services. During the ramp-up period, the government can decide to cover these costs as an interim solution.
How long will this program take to become fully implemented? It could reasonably take ten years to be completely fielded from incoming students to fully certified HSPs. Two interim programs can be put in place to alleviate the healthcare problem while the program and HSPs progress through the pipeline. The first interim plan would be to enroll current healthcare professionals into the program with the benefit of paying off school loans and covering malpractice insurance requirements. The second interim plan would be to cover the requirements at current costs until the HSP program can provide the service. Each of the above is a short-term ramp-up transition method to cover the uninsured.
What will keep currently insured citizens from dropping their insurance and being covered by this program? An assessment of employment and access to insurance from the employer must be made. If the person is not employed or the employer does not provide healthcare, the person will be eligible only if annual income is below a level that would not support private insurance. This last element will keep independently wealthy personnel from not getting insurance that they can afford. Additionally, the HSP plan does not cover all costs, so a citizen will not desire to drop coverage knowing there are additional costs to be covered.
What will stop employers from dropping insurance knowing that the HSP option exists? The labor market will keep employers from dropping insurance. Prospective employees will desire to work for a company that provides comprehensive healthcare. The HSP plan does not cover all aspects of costs. Thus, market forces will drive quality labor to the companies that provide better benefit packages.
What happens to the HSP after the pre-determined commitment period? It will be a mutual decision between the HSP and the government as to whether the HSP stays in the government service or goes into the private market. A certain number of senior HSPs is desired and will be managed similar to the officer corps of the military.
Benefits: There are many aspects to this plan that are based on common sense and a desire to solve the problem. These include:
• Focusing and solving the problem of the uninsured patient. The program covers a large portion of the costs (labor) to the uninsured patient. This plan will preclude going bankrupt due to a health issue.
• Doctor-Patient decisions remain personal and within the control of the patient.
• Costs of Medicare, Medicaid and Private Insurance programs will be reduced.
• Quality service will be guaranteed base on the program being a highly competitive program that will include the best and brightest.
• Private practice, hospitals and group practices will all benefit from a government salaried employee as a part of their system. These resources will cover the uninsured and Medicare/Medicaid providers. This will make billing easier to manage and allow private healthcare professionals the ability to treat fully insured patients.
• Taxpayers receive a benefit based on insurance cost decreases due to the HSPs providing treatment to insured individuals. These costs are not billed to the insurance company. These savings will result in lower overall insurance costs spread across the total insured population.
• The taxpayer can be comforted that this type of program has been successful in the government as is not a new untested bureaucracy.
• The taxpayer can also understand that the costs are not going to a government program or a private company. The costs are directly going into the education and training of American citizens to treat and care for American citizens.