If I were queen of the world*, the health care reform bill before congress would be shorter, sweeter and more to the point than the present one, and would be passed by a majority of both political parties. Like the present bill, it would attempt to improve quality, reduce cost, and allow everyone who needs it access to health care. Unlike the present bill, my reform bill would not include measures to improve health behaviors specifically, because that is just too much for a single piece of legislation.
(*Now if I got to be god, instead of just queen of the world, I could make more radical solutions happen, including an affordable single payer or a system that used insurance only for very high priced outcomes, along with prices for health care that were low because of lack of insurance administration costs.)
Goal 1: Allow access for everyone to medical care
• Create one website in which all insurance companies could be represented, and have these participating companies offer a single, low budget plan which would be available to everyone, regardless of need. Medicare would be one of these companies. The cost of the plans and the coverage would be decided on by consensus between all the involved insurance companies with an advisory board including doctors and public health officials. There would be telephone operators who would be able to assist people without computer access.
• Everyone would be mailed a summons to sign up for insurance, with information on how to access the website or operator.
• Everyone would be required to sign up or provide proof of insurance by an employer or private insurance.
• Payment for these policies would be based on a simple sliding scale of ability to pay.
• Insurance companies would be reimbursed at the end of the year by the government for costs exceeding income from premiums, within a certain budget.
• Each insured person would be issued a health credit card that would carry insurance information and a link to computerized medical records. Billing would be done directly online when the provider documents the visit, based on resources used, and would not require billing clerks.
Goal 2: Improve quality of health care and reduce cost and waste
• A simple and elegant medical record system would be created, for online use, by the best minds in medicine and information technology. This would be free to all providers and would be accessible via the internet to all providers, with privacy protection, and with links to individual medical records through the health credit card.
• Advisory boards in each state made up of providers, medical cost specialists and public health advisers would be funded to pinpoint areas of waste and care inadequacy. This would include evaluations of preventive care practices. These boards would be in charge of administering innovative care grants and grants for improvement in health of communities.
• Each state would be charged with the responsibility to re-design the system of malpractice compensation so that the total cost of administering the system was decreased, malpractice insurance costs were significantly decreased, and significantly more injured patients were compensated. These changes would need to prove that they also contributed to reducing medical harms. If at the end of 3 years this was not achieved, the states would be subject to a system designed federally.
• All providers of health care would be required to post prices charged for all services.
• A board would be created of doctors, nurses and administrators, charged with reduction in complexity of documentation. Studies of time required for documentation in office care, hospitals and nursing homes would be performed, and at the end of one year, recommendations would be produced that would reduce that time by 50% with the eventual goal to reduce time spent on documentation to 10% of present standards.
• Federal government would subsidize continuing education classes for providers in cost effective medicine including appropriate use of technology at the end of life, with enhanced reimbursement to practitioners involved in such education.
• Budgeting for payment for providers and services would be determined by consensus of the insurance consortium, including their health care provider advisory board.
• The consortium of insurance companies which includes Medicare would be charged with designing a commission to investigate insurance billing fraud and overbilling, to be paid for by the consortium as a joint effort.
Goal 3: Ensure an adequate health care workforce
• Immediately provide stipends to support medical education for primary care including general surgery, pediatrics, family practice and general internal medicine based on need. Also provide stipends for nurse practitioner training and for training physicians’ assistants.
• Change the relative value scales of payment of primary care and procedures so that primary care visits are reimbursed at a higher level.