A Healthcare Solution for America

The healthcare solution for America is simple, but it certainly isn’t easy.

While the United States arguably has the finest healthcare professionals and treatment facilities in the world, many Americans cannot get access to our outstanding healthcare system because of the prohibitive cost, insurance restrictions, and arcane government regulations that work against wellness in our country.

It’s time to move beyond the finger pointing, doubts, and philosophical arguments by special interest groups and adopt a national healthcare reform program in which every American can participate at little or no cost. The solution is the adoption of a progressive healthcare program for the United States which would be created by an Act of Congress, paid for mostly by taxpayers like you and me, and managed by an independent, non-profit agency under the direction of the Secretary of the Department of Health and Human Services.

I am proposing a program that would be voluntary. But, I believe its strength and innovative approach would attract more than 90 percent all of medical professionals, universities, clinics, non-profit service agencies, and industry organizations that currently serve the healthcare industry in America. I also think it would set a precedent for other nations that wish to provide a universal healthcare benefit for their citizens.

Let me note that I am neither a physician nor healthcare expert. Frankly, I don’t think those credentials are necessary or beneficial in this discussion because those individuals -- and rightly so -- have devoted their adult lives to healthcare and, thus, they have hardened opinions and biases as to whether or not a national healthcare program is a good idea and how it should be managed. I think we need to get past those discussions and, at the appropriate time, seek the input of healthcare professionals on how to best manage a program.

Also, I have not been asked to write this article, nor am I being paid for it. Finally, I am not championing the cause of any special interest group. I am simply a citizen who has worked in the non-profit sector for many years and I currently pay a substantial monthly premium for my healthcare insurance. To date, my insurance provider has been responsive and fair to me. I have no issues or complaints with my insurance provider or any of the outstanding medical professionals who have cared for me over the past fifty years. I have never suffered a major health issue, and I count myself fortunate that I am able to afford healthcare insurance although it becomes more expensive each year.

Having said that, I think our healthcare management and distribution system is broken and needs fixing. I am appalled that every American does not currently receive free primary healthcare services as an entitlement of their citizenship. It’s time we emerged from the dark ages of “healthcare for the privileged” and adopt a progressive healthcare program that provides outstanding healthcare for all Americans and legal visitors to our country.

But, who will pay for it, you might ask? The honest answer is that it will be paid for by you and me -- the taxpayers of the United States of America. Nothing is free in the Land of the Free, but there are certain things that every American needs and should demand. A quality education and comprehensive healthcare are two such things that will raise our standard of living and create a stronger nation. I believe a national healthcare initiative is the most efficient and comprehensive way to advance healthcare for all and will keep the costs from spiraling out of control.

My motive in proposing a national healthcare initiative is selfish. I want access to the best healthcare in the world for the rest of my life -- whether I live a thousand days or 10,000 days; and, I don’t want to be told by some faceless individual working in a corporate building whose job it is to save his/her insurance company money, that a vital medical procedure, treatment, or drug will not be authorized because their bottom line is valued more than my life. It’s that simple! Here’s a true story that illustrates my point.

A few weeks ago, I read a very disturbing front page story in the Wall Street Journal about a middle-aged woman who worked in a small town in Texas as a hairdresser. She discovered a lump in her breast and went to a private hospital for diagnosis and care. Unable to pay for the necessary treatment, she was shuffled from one doctor to another over several months until a free service could be found. Regrettably, she was denied the proper care because she was unable to pay the costs for her surgery. Furthermore, federal regulations that would have allowed for free treatment, were unknown to the patient and she was caught in a Catch-22 cycle. Eventually, the woman died despite receiving a mastectomy and good follow-up care in Colorado where her daughter lived. The patient had to sell her home, relocate to Colorado, move-in with her daughter, and be subjected to the humiliating rules of the state and federal healthcare bureaucracy. Despite the heroic efforts by her daughter, who was a nurse, to get her mother timely and proper care, the patient died from the cancer. But, as I read this heartbreaking story, it occurred to me that the woman’s death was also expedited by insensitive people in the healthcare industry who made a series of life-and-death decisions to deny her treatment in the early stages of her diagnosis. Had that been their mother, I am sure the roadblocks and outdated regulations would have been removed to facilitate the best possible care. This is not only a tragedy but a disgrace to the dignity of every American. Frankly, reading this story angered me because nobody should deserve to suffer and die -- let alone go broke -- when the best medical care in the world is readily available. There are certain national issues and causes whose interests are poorly served by the twin engines of capitalism and profit. Healthcare is one such issue.

So, here’s my proposal to remedy the healthcare problem in America.

Step 1. Create the National Healthcare Foundation.
The United States Congress should approve and fund a National Healthcare Foundation (NHF) within the Department of Health and Human Services. The role of the NHF would be to administer a national healthcare program through a network of state agencies that entitles every American citizen and authorized visitors (tourist, student, visa holder, etc) to unlimited primary and emergency healthcare services for any treatment that will enhance their wellness or preserve their life.

At the core of this innovative national healthcare program would be a network of medical facilities, hospitals, shelters, clinics, and providers who would all be required to operate as independent, self-operated, not-for-profit entities. In other words, no shadow subsidiaries would be allowed in order to protect the integrity of this reformed healthcare service. Obviously, this would require many for-profit medical facilities and hospitals to change their status from “for-profit” to “not-for-profit” in order to participate. It might even result in some for-profit corporations selling off certain facilities or medical practices to convert them to not-for-profit status. Individual physicians and other medical professionals would be exempt from this requirement and eligible to participate in the NHF provided their billings were directed through a not-for-profit entity such as an eligible hospital or clinic.

Step 2. The National Healthcare Foundation (NHF) will be funded and paid for by the United States Government through its taxpayers. Every citizen has the right and privilege for primary and emergency healthcare under the same legal protections that ensure “life, liberty, and the pursuit of happiness.”

I estimate the annual cost for this program as outlined herein would be $350 billion in its first year. It would not be cheap; the cost of good healthcare never is. But, this is also a way to control the spiraling costs of healthcare, and, as you’ll read, we can achieve a significant return-on-investment within three years of this plan through some innovative methods and self-funded programs. In three years, this program could actually cost us less than we are currently spending on healthcare today.

As part of the new NHF, all physicians, nurses, clinicians, pharmacists, researchers, technicians and other healthcare professionals -- as well as all healthcare facilities such as hospitals, teaching universities, clinics, and laboratories -- would be paid a fair market wage or fee for their services based on current wages and fees-for-services. These wages and fees would also be reviewed annually for cost-of-living adjustments. This proposal does not require anyone -- doctors, dentists, nurses, clinicians, teachers, administrators, or technicians -- to take a pay cut. These people are professionals and deserve to be paid a premium wage for their services.

As part of this proposal, Congress would create an independent Healthcare Compensation & Insurance Commission (HCIC) within the NHF consisting of nine individuals appointed by the president and confirmed by the Senate from the private and public sector who would establish a code of ethics for all NHF participants and an annual compensation and fee-for-services schedules that ensure fair compensation for all medical professionals and participating non-profit healthcare and educational institutions. The HCIC would also establish regional malpractice insurance rates and approve jury award limits for financial claims against medical professionals and institutions that are sued for malpractice and related claims. This would dramatically reduce the exorbitant cost of malpractice insurance.

Step 3. The National Healthcare Foundation (NHF) would consist of ten divisions. The purpose of these divisions is not to ensure adequate representation for the healthcare industry, but rather, to ensure all Americans receive primary and urgent healthcare as well as foster the research, education, and advancement of the healthcare profession. Each division is described below in general terms outlining their major roles and responsibilities. Additional divisions could be created as warranted.

Primary Care
Urgent Care
Assisted Care, Long-term Care, Child Services, Shelters, Hospices, and Therapy Services
Research & Technology
Organ Donor Programs
Education, Training, and Accreditation
Wellness Treatments
Licensing, Regulations, and Insurance
Payment, Audits, and Enforcement
Administration

1. Primary Care would include areas such as pre-natal, pediatrics, dental, oral surgery, family physicians, orthopedics, chiropractics, and other traditional medical practices (there are many more than can be listed here) that care for patients through office visits and preventive disease treatments. Primary Care would also include care for the developmentally disabled, mentally impaired, and treatment programs for diseases such as alcoholism and drug addiction. The NHF would pay for one hundred percent of these services based on a regional formula that fairly reimburses physicians and/or medical providers such as hospitals, clinics, and social services agencies. In other words, a family physician in New York City might be reimbursed using Schedule A while a community clinic in Albany might be reimbursed according to Schedule B. The adoption center in Macon, Georgia might be paid according to Schedule C and so forth.

2. Urgent Care is defined as any medical treatment that requires emergency room-related services and ambulatory services to treat life-and-death situations such as heart attacks, seizures, car accidents, shotgun wounds, etc. Such care would be provided by licensed emergency rooms or 24-hour emergency care clinics located across the nation. This non-profit network currently exists with the exception of several rural and poor communities that desperately need medical professionals and local facilities. This level of service would also apply to animal care through veterinarians with a limited annual dollar amount for pet owners. The NHF would pay for one hundred percent of these human services based on a regional formula and payment schedule that fairly reimburses the medical providers for their services and procedures. Veterinarian care would be reimbursed at fifty percent of the cost with pet owners paying the remaining balance.

3. Assisted Care, Long-Term Care, Child Services, Shelters, Hospice, and Therapy. This division would advance the needs of those persons who are unable to independently care for themselves including persons suffering from mental illness, Alzheimer, AIDS, and terminal illnesses. This division would also be the champion of children who require adoption, foster homes, and day-care services for working parents. This division would also support the needs of persons requiring mental or physical therapy.

This division of services also would include those patients who require assisted care living or long-term care situations including hospices. Also, it would apply to those patients who are under psychiatric care, medical counseling, the aged, developmentally disabled, persons suffering from physical injuries including paralysis, or persons requiring rehabilitation treatment and therapy.

This division would also fund homeless shelters, runaway shelters, and homes for victims of family violence or spousal abuse. The NHF would also provide greater grant funding to support various state and county government social service agencies.

The NHF program would pay for ninety percent of these services. The other ten percent would be funded through private contributions, grants, and fundraising activities. Patients or family members would not be charged any fee for receiving these services.

4. Research and Technology would advance and encourage the development of innovative medical practices including new medical procedures and treatments, product design, drug research, and other such developments that would enhance the advancement of medicine and its treatment of patients. The NHF program would pay for eighty percent of these services to bona fide not-for-profit institutions and research centers. The other twenty percent would be funded through private sector and public sector grants, individual contributions, and fundraising or advancement campaigns. For profit entities including drug manufacturers would fund their own research and be eligible for grants under other federal agency programs as is currently the case.

5. Organ Donor Programs. This division would advance the existing international network of organ donors, recipients, maintain a national database, and work to promote public awareness and support for organ donations while expanding the international network. This program would be completely funded by NHF including the costs associated with transporting patients, family members, and organs for a medical procedure.

6. Education, Training and Accreditation. This division’s mission would be to advance enrollment and training capabilities of teaching universities and hospitals as well as all other certified and licensed not-for-profit educational institutions that train medical professionals including doctors, nurses, and technical professionals. The NHF would pay for ninety percent of a student’s educational and medical tuition or training that requires a medical degree or healthcare professional certificate. The remaining ten percent would be paid for by the student or through scholarships and grants. The cost of continuing medical education programs would be borne by the individual unless it leads to a medical degree or post-degree certification.

A scholarship program would be required of each participating not-for-profit teaching institution to fund “special need” applicants and non-residents (foreign citizens). Institutions would be required to fund all non-educational programs and services such as administration, facilities management, and human resources as is currently the case. All students receiving funding support from NHF would be obligated to serve-with-compensation in an NHF-certified healthcare facility or practice of their choosing for an period of time equal to the funding they received from the NHF. The current system for accrediting medical colleges, schools, and universities would remain in place and not be funded by NHF.

7. Optional Treatment and Wellness Programs. This division of the NHF would be responsible for overseeing and advancing those medical treatments that are deemed non-life threatening but do enhance the health and self-esteem of individuals. Cosmetic surgery, plastic surgery (not required from a related illness or medical emergency such as an auto accident or burn incident), and wellness treatments such as spas and weight loss clinics would be covered under this section. The NHF program would pay for twenty-five percent of all such services with an annual and lifetime limit expenditure-per-person to be set by the HCIC.

8. Licensing, Regulations, and Insurance. This division of NHF would be responsible for overseeing three key areas -- licensing, regulations, and insurance programs associated with the NHF.

In the Licensing area, all not-for-profit medical facilities seeking to participate in the NHF program, and receiving any federal funds through the NHF, would be required to be certified by NHF or its designees. For example, a not-for-profit medical lab in St. Louis would have to apply for “NHF Licensing” in order to participate in the volunteer NHF program. Certain licensing reciprocity would be available -- including any hospital, laboratory, or medical facility that is accredited by the Joint Commission -- so long as that facility maintained its Joint Commission certification.

The Regulatory unit of NHF would oversee two major reforms that effect healthcare. First, the creation of a national malpractice insurance fund to protect all practitioners and facilities; and, secondly, oversight for the regulation, distribution, and enforcement of all “Re-classified Prescription Drugs” including many of those drugs that are currently deemed illegal today such as marijuana, cocaine, and heroin. These particular reforms are urgently needed in order to curb excessive malpractice insurance rates and end America’s fledgling war on illegal drugs which is costing taxpayers hundreds of millions of dollars. Here is how these two reform programs would work in concert with other federal agencies.

A special Malpractice & Medical Claims Insurance Fund (MMCIF) would be established by Congress as part of the enabling NHF legislation to cover all medically-related lawsuits or malpractice claims against program participants. Why? Because this element of the NHF is the “hook” that will single-handledly encourage over 90 percent of all physicians, dentists, and other healthcare practitioners, who must pay costly malpractice insurance premiums, to enroll in the NHF and support its success. Also, as a volunteer program, the benefits of participating in the NHF must be significant in order to attract widespread national participation among medical professionals and medical care facilities. Regardless of their status as not-for-profit entities or for-profit businesses, medical professionals and healthcare institutions will follow the money! It’s the American way.

Under this proposal, the MMCIF would pay up to ninety percent of all medical malpractice insurance premiums -- as established by the HCIC -- and have the power to cap the dollar amount for all malpractice claims as part of their independent administrative law authority. Participants (physicians, dentists, and healthcare facilities) in the NHF program would pay the remaining ten percent which would sufficiently fund the malpractice program as well as other activities of the NHF. The NHF would be able to contract with insurance companies and agents across the country to administer this program and ensure all participants are in compliance. A reasonable fee-for-service, as approved by the HCIC, would be paid to these companies and agents for their services.

The second major reform deals with solving America’s problem with illegal drugs. Each year, the United States Government spends billions of dollars trying to stop the flow of illegal drugs into our country and arrest, prosecute, and imprison drug offenders and traffickers. While the merits of this effort are laudable, it is a costly war that requires a different solution in today’s global environment. That solution is not the legalization of drugs, but rather, a program that would allow for the regulation and distribution of those drugs under a system similar to our current prescription and pharmaceutical distribution of prescribed drugs.

Under this proposal, the Food and Drug Administration would authorize American-owned drug companies to manufacturer certain drugs in various dosages -- including marijuana, cocaine, and heroin -- to ensure these prescriptions meet rigid federal guidelines for dosage and/or treatment. Federal and state healthcare agencies that oversee current licensing requirements for pharmacies and other prescription drug providers, would license certain drug distribution facilities to dispense medically-approved prescriptions of those drugs to persons who require them for medicinal purposes or to treat their addiction. As part of any legal prescription from a physician, every patient using these “recreational” drugs would be required to participate in a licensed counseling and treatment program which would be paid for by the NHF as part of its Primary Care Division.

This drug reform program would have many beneficial effects. First, it would severely reduce the activities of illegal drug cartels in foreign countries and allow the Drug Enforcement Agency (DEA) to focus its vital resources on other important activities. Secondly, it would reduce property crimes and felonies by drug users who must “feed their addiction.” Thirdly, it would reduce gang violence in major cities and reduce the need for gang involvement. Fourthly, it would allow the medical community to adequately treat people with addictions. Fifth, it would reduce the prison population since more people will receive treatment for substance abuse in a medically-controlled environment and, thus, they will not be engaged in criminal activities nor be imprisoned for criminal offenses. This program would be funded completely by NHF. The cost savings to DEA and other drug-fighting agencies justifies this reform proposal.

9. Payments, Audits, and Enforcement. The NHF would establish a Payments, Audit, and Enforcement Division to handle all claims and funding requests from program participants. By law, payments for treatment and services would be paid within thirty days of billing to all approved, first-party payees (physicians, hospitals, clinics, etc) or the NHF would be required to pay interest to those providers. The NHF could contract out payment services to approved third party contractors or state agencies.

The Audit Division would be responsible for overseeing compliance of all NHF and HHS rules and requirements for billings and payments.

The Enforcement Branch would be given full federal law enforcement powers and be responsible for enforcing all NHF and HHS laws and regulations. Alleged violators would be referred to the United States Attorney for prosecution. Violators also could be fined, imprisoned, or banded from NHF program participation if found guilty of fraudulent activities or unethical conduct.

10. Administration. This division would encompass the typical administrative and support functions of a major government agency including but not limited to: human resources, government relations, inspector general, legal, regulatory affairs, and budget.

In Conclusion:
This description is not meant to be all encompassing, but rather, it is an attempt to further the discussion on how to establish a progressive healthcare program that ensures all Americans will receive the finest medical care in a timely and affordable manner.

Certainly, there will be some people who do not believe in free primary and urgent medical care. Others will argue the national cost for such a program is too high. I would strongly disagree with both arguments because I believe that every human being has the right to life, liberty, and the pursuit of happiness. I also believe that wellness and health play a major part in that formula. If we do not create a meaningful healthcare solution soon, the costs will soar beyond our control. A progressive healthcare program is the right thing to do given who we are as a people and what we stand for as a nation. Certainly, a network of not-for-profit healthcare facilities, staffed by America’s best-and-brightest medical professionals, would be money well spent and enhance the quality of life for all Americans.

Also, let me comment on the naysayers who are critical of national healthcare programs in England, France, Canada, Australia, and elsewhere. I am not suggesting that these program must become our model. Nor am I suggesting that we must emulate all of their practices. But, I am suggesting that if those programs were terrible, citizens would be revolting in the streets. So, there must be some merit in those programs. My question is this. What are their best practices? And, secondly, can we apply those best practices to a “Made in America” healthcare model?

In closing, I would not wish it upon anyone to be that person who must look your mother in the eye and tell her, “I’m very sorry, but we will not treat your breast cancer at this physician’s office or medical facility because you don’t have adequate insurance and our doctors aren’t able to take on any more charity cases.”

Regrettably, those words are being repeated over and over every day in medical offices and insurance companies by otherwise caring people whose job it is to put profits ahead of the healthcare needs of human beings. It’s time we put an end to this unethical and inhumane practice in the United States of America. Through this proposal we can achieve something significant that all Americans will be proud of.

I welcome your comments.

Tom Hinton
www.tomhinton.com