OUTLINE OF A PLAN FOR A BICAMERAL HEALTH-CARE SYSTEM

Charles Harris MD

The Health Care “System” in the United States breeds discontent among patients and doctors because, among less glaring reasons, it is incoherent and costly. Performance excels at the High Tech level, gets variable grades at the Specialty level, and fails at Primary Care if for no other reason than the fact that 47 million US citizens and others bereft of Healthcare Insurance, flood busy Emergency Rooms for non-emergent often trivial problems.   Other systemic reasons for failure at the Primary Care level are noted in the addendum.*    Plans currently floated by presidential candidates to cure the system have not enthralled the public.  Below is a brief outline of a patch designed to heal some glaring deficits in the system. 

 

 CURRENT STATUS

 

1.    The United States Health Care System is comprised of the following:

a.    HMOs (private)

b.    Medicare (Government)

c.    Private and personal

d.    Indian (Native American) Health Care Government

e.    Uninsured (between 37-42 million)

 

 

 

 

2.    Coverage is provided by:

a.    Physicians in their offices    

                                                                         i.      Primary Care

                                                                       ii.      Specialty Care

                                                                    iii.       Stand alone clinics for endoscopy, surgery, dialysis

 

b.    Hospital based Departments

                                                                         i.      Emergency

                                                                       ii.      Radiology

                                                                    iii.      Laboratory

 

REMEDY:

 

 While politicians, economists and professors thrash around with numerous fixes for the ailing system, a simple patch is available that might be put in place as quickly as politicians get serious about the problem.

 

Namely: create a bicameral system, one public and one private. The Private system currently exists in the form of HMOs. The second component would be a Public Single Payer System devoted solely to Primary Care-Family Medicine.  The Primary Care Centers will be staffed 24/7

 

1.    Benefits of this Primary Care Single Payer System (PC-SPS)

a.    Immediate Primary Care coverage availabe for the 40 million who currently have no medical insurance.

b.    Primary care available for anybody, whether insured privately or by HMOs; whether documented or not; a guest, a traveler a homeless person. One and all.

c.    The system will relieve Emergency Rooms of the burden of people flocking and congesting these centers for simple ailments normally handled in a doctors office, because they are not welcome elsewhere.

d.    The PC-SPS should relieve HMOs of the burden of a significant portion of Primary Care, thus enabling them to concentrate energies on monitoring and funding High Tech and specialty care.

e.    The PC-SPS gives the public a chance to compare the efficiency of public and private systems.

f.       Physicians practicing withi9n this system would be relieved of pressures and unforeseen consequences of unprincipled flourishing litigation.

 

2.    Funding

a.    General Taxes

b.    Tithes from HMOs now relieved of much of Primary Care Costs

c.    Contribution from Businesses enterprise and Industry. Business and Industry will be able to dispense with full Health Care Covereage since most in th labor roles under 55 need little more than comprehensive primary care. Industrial accidents should be covered by insurance.

d.    Minimal fees and contributions

 

3.    Office Space to be made available and equipped at:

a.    Veterans Administration

b.    Public Health Service

c.    Hospitals

d.    Schools after hours

e.    Churches Synagogues Mosques

f.       Trailers, etc.

 

3       Staffing

a.    Physicians finishing training

b.    Retired or retiring

c.    Others who want good hours and steady salaried work

 

*Primary Care doctors practicing in the current environment are policed not only by litigation, but by HMOs that themselves fear becoming involved in matters that even hinting at the “L” word. Good Primary care by definition requires that the physician supervise the care of his or her patients; do primary spadework; have some competence in the office practice (diagnosis and treatment) of specialties such as neurology, urology, dermatology; be comfortable injecting trigger points, tapping a swollen joint, injecting a bursa and checking urine though a microscope. But the patient’s lament today is “all he does is write prescriptions and refer me.”

 

Hopefully a Single Payer Primary Care System will be constructed to expand the scope of Primary care, unloose the reins and give its doctors the opportunity to become physicians.