If I don’t like it, offer a suggestion for improvement.

Here’s my recommendation for improving the healthcare system in the USA. It goes farther and deeper than the ACA (“Obamacare”), and with some folks won’t be any more popular. But as a healthcare worker for over 20 years, I believe it would work.

#1. Everyone take some responsibility for the healthy or unhealthy choices in their living. NO ONE should have free health care– everyone needs to have a stake in the process. Income-index every medical visit and procedure, even for Senators and street people. If a person is truly indigent and completely cashless, let them give service in exchange for their medical care. Caveat– see number 4.

#2. Facilitate health education for every family and in every school; more than First Aid and nutrient pie-charts. Eliminate the “food ghettos” where nutrition is unobtainable and eliminate the social “norms” wherein ignorance or disdain of the outcomes is par for the course.

#3. Stringently outlaw non-food items being marketed as food. Zone and plan for and create community gardens, neighborhood butcher shops (and back-yard chickens and fish tanks). Make “locovor” the norm. Eliminate the rampant use of preservative chemicals to make things look and smell nice long past their useful existance as food.

#4. American “christians” increase their “charitable giving” by merely 1% of their income, and the churches pay for or directly provide what is needed by those who are utterly unable to pay.

#5. No free medications for families of cigarette smokers. If you can’t buy your child a $4 bottle of cough syrup then skip your next pack of cigarettes and do what’s right for your child. If that won’t work for your level of addiction, go beg from your neighbor and admit you care more for your own comforts than the needs of your child. Maybe then you can, in the contex of a relationship with someone who cares about your child, learn to love her too.

#6. Increase Home Health Care visits– make them the norm instead of the exception for the care of the elderly. Do not require “homebound status” for elderly adults in order for them to receive the aid they need.

#7. Create a price unification system so that every one can find out ahead of time what any given procedure will cost. Under the current system (only entrenched by ACA) a single ER visit may commonly result in 5 different bills: hosptial ER, ER Physician group, Radiology, Lab, Radiologist’s Group. These layered and split billing systems, with different prices for each insurer and yet another different price for self-payers, obscure the actual cost of a procedure and render the healthcare consumer powerless in deliberating risk-benefit equations. We must restore power to the individuals who are needing and receiving the care.

#8. If a third-party payor system is needed, let them all offer the same “product” and let them differentiate from one another in the form of “cafeteria-style” benefit packages ,deductible levels, and service responsiveness. The current system makes it nearly impossible to compare “Apples to Apples” when shopping for insurance.

These are my suggestions for improving care, improving health, and reducing the horrible expenses, wastes, and neglects of the USA medical system. Will it be painful for some? Yes. But in 1-2 generations we would see an immense sociological shift in healthcare expectations accompanied by excellent clinical outcomes.

4 thoughts on “If I don’t like it, offer a suggestion for improvement.

  1. I like much of what you said, and concur with “Ann”. Much of this you described is already in place in Canada, but to large degree healthcare in the Western hemisphere is controlled by bigger interests than what is implied by individual responsibility. Years ago one of my clients who was a nursing student answered a question posed by his instructor -“What can be done to improve health care?” – by saying two words: “Eliminate profit”. The large corporate interests involved in the food production in this country and elsewhere, medical care and medical products manufacturing, delivery and distrubution, transportation, taxing bodies, etc. etc…. all would have a major hissy fit if the measures you suggest are instituted. Maybe if a small/medium sized community got together and agreed on a strategy such as yours a model could be develped that would actually work, but in a free society, voluntary participation is key. If we don’t want a free society to live in, we could look at a model such as the one in Cuba where much of what you suggest has been in place since Che Guevara’s old med school buddy developed the medical system there. I know some Canadians who fly down there every year for their annual check-up, tune-up, med purchase, etc. They’re pretty happy with it and Cuba is glad for the Canadian dollars….think it all kind of interesting, actually. Hope I’m not around when it all falls apart, as it will eventually, but God have mercy on our kids and grandkids….

    • Agreed! I cringe daily, knowing that much of what I do in a hospital is driven by corporate profit incentives. I am thankful that my current practice setting at least allows for enough time and space with my patients (some of the time) for me to engage them with new information or encouragement that will help them to actually heal up.

  2. To a significant degree, you are describing Europe’s approach. Universal health care tends to lead to these outcomes. As to #5, unfortunately, any number of people addicted to any number of substances/activities have shown historically that their addictions come before their children. I don’t believe that their children should have to suffer for that on top of suffering from the addicted parent.

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