The healthcare wars are heating up as the various groups stake out their positions. I don't follow the political side of things much, but I do read the proposals with a lot of anxiety these days. The reasons I'm nervous mostly center around fiscal issues. Bluntly, I see affordable healthcare for all as not being some kind of luxury that Americans want but which may have to wait indefinitely, its a matter of life and death for many people. Various estimates have from 20,000 to 100,000 Americans dying and a much larger number of our people becoming permanently injured because of preventable injuries caused by lack of access to affordable medical care each year. These injuries simply would not be happening in Canada or the other nations with functional universal healthcare systems.
The American people overwhelmingly support a national healthcare plan, like Canada's. Most Americans envision this as being a national healthcare service, not simply another insurance "option" that costs as much as private insurance or more.
There are a number of serious concerns that I share with quite a few others about the direction we take on health care reform.
1.) We should focus on affordability. If we do not succeed in making quality healthcare, doctor visits, hospital care, dental care and all other necessary medical services and prescriptions affordable for all Americans within a modest percentage of their income we will not have succeeded and no body outside of Washington will consider the job as done.
2.) Americans should not have to "apply" for "subsidies" and "subsides" should not be arbitrarily cut off at some percentage of FPL, instead, we should pick a target percentage of a family's income, say 5% and limit all uncovered costs to that amount, pegging all medical costs to that percentage. The healthcare plan should not be a welfare program, like Medicaid, and it should not be considered as a loan. It should not be a welfare benefit. The percentage of income should be the premium, and the insurance should be the default that all people have, unless they have some other insurance. If they lose that other insurance, the public plan shuld kick in automatically.
3.) A person should be able to go to a doctor, pharmacy or hospital and receive services by giving them their healthcare card or giving them their healthcare number. (This should not be one's Social Security number)
4.) people should not have to fill out any forms "applying for subsidies". People's normal tax forms will provide enough information. In particular there should not be any deliberately humiliating forms.
5.) A national healthcare plan should not require that people pay co pays and deductibles that are designed to make it difficult for people to go to the doctor or fill prescriptions.
6.) Health coverage should not be subject to the whims of legislators and their willingness to steal from Peter to pay Paul. People, healthy or espcially sick, should never be subject to any 'penalties' for ANY reason.
7.) National affordable healthcare should not be viewed through the twisted lens of our dysfunctional current system. Whatever arrangements people have with private insurance carriers are completely separate and should not be used as a way to reduce or limit expectations.
8.) Healthcare costs should not be used as a means of discouraging the employment of older people and encouraging the employment of younger people. Effort should be made to eliminate any disincentives to employers to hiring new employees by tying healthcare fees or taxes to number or age of employees.
9.) Businesses should not be tapped as a source of money to pay for health care. The costs of the new healthcare program should be taken from taxes in an aggregate manner and not tied to a businesses number age or especially, health status of their human employees. If taxes are levied on businesses, the taxes should be based on some other measure of business volume, not number, etc of employees. (Perhaps total volume of business or compensation paid to all employees and executive management?) Businesses should not be discouraged from hiring human workers and encouraged to replace humans by the structure of healthcare taxes.
10.) A new Federal office dedicated to improving the health of Americans and reducing healthcare costs should be set up. It should include power to protect and reward whistleblowers who reveal corruption related to healthcare issues and power to prosecute officials and corporations and corporate officers..
11.) Americans should be allowed to purchase prescription drugs from overseas pharmacies if they cannot find them domestically. Orphan drugs not commonly available in the US should be allowed to be imported and sold at cost.
12.) "Off label" use of prescription drugs that have shown to be effective in treating illnesses by physicians should not be limited or controlled in any way. Physicians should be given the ultimate authority in how they treat their patients. Insurance industry vendettas against physicians who treat sick patients should be prohibited.
13.) Private insurance companies should be held to a far higher standard of professionalism than they are now. A clear chain of accountability for decisions and liability should be established. Any decision to deny care should be automatically appealed if the patient desires within three business days. If a patient cannot afford a lawyer, a lawyer should be provided to them. Physician gag clauses should be prohibited by law and all existing gag clauses in contracts declared null and void.
14.) Physical or virtual federal centers of excellence should be established to concentrate research in clinically important or emergent diseases. Open source collaborative software to allow these centers to act as clearinghouses for research on these illnesses should be developed and standard tools provided to all centers of excellence. Patients as well as doctors should be enlisted to increase the knowledge we can apply to eliminating chronic diseases.
15.) Quality of patient care should be established as the milestone by which all health programs and policies are evaluated by, not politics. Effort should be taken to prevent politicians from disturbing medical programs. Finances should be isolated from the healing arts. The goal should be massive simplification. Doctors should ultimately not have to maintain billing staffs.