Universal healthcare: a bold proposal.Conn Med. 2000 Aug; 64(8):485-91.CM
One problem with the American health-care system today is not that it's too expensive but that it's too wasteful. The amount spent on health-care in the United States is sufficient to take care of the medical needs of every citizen. The reason that it does not is that the money is far too often is misspent. America already is spending 14% of the gross domestic product and yet we have health-care chaos and 44 million uninsured. Another problem is the lack of trust between payors, insurance carriers, regulators, employers, employees, providers, and patients. Although the financing aspect of health-care is tremendously important, it is even more important to design a plan to spend the money wisely, align the incentives of insurers, payors, patients, and providers, and restore trust between parties. Otherwise we shall continue to be in chaos regardless of how much money we spend on health-care. In this article, we outline our proposal for an ideal comprehensive national health-care plan that will guarantee that we spend our health-care dollars wisely. Our plan would cover all Americans, including the 44 million uninsured, and it would do so at less than the cost of the current system. Because insurance companies are not equipped to oversee medical practice, our plan would place the day-to-day management of the health-care system in the hands of physicians and local physician-run, physician-owned "provider groups." The physicians in these provider groups would be charged with two primary responsibilities: 1) clinically, they would be responsible for providing total quality cradle-to-grave health-care for every patient in their group and 2) economically, they would be responsible for the budget and to spend it wisely. Physicians will be compensated fee-for-service plus an incentive for efficiency, patient satisfaction, and outcome in a broad sense. Physicians would enjoy wide latitude in clinical decision-making without being second-guessed by distant third parties. Our plan places the fiscal responsibility on physicians while at the same time establishing a system of checks and balances to ensure that patients are protected and well cared for. Unlike outwardly similar plans, under this proposal the physicians are owners of the provider groups and the incentives between payors, insurers, providers, and patients are better aligned. It will eliminate the debate about giving patients the right to sue health plans and employers. It would empower large legally organized physician groups to negotiate with insurers. Our plan is a model for spending money wisely. We believe it would benefit, and therefore be embraced, by all parties--physicians, other healthcare providers, employers, insurance companies, the government, and above all the American public.