An essay regarding what’s going to happen with Universal Health Care in the United States.
By Burton A. Waisbren Sr. M.D., FACP
There is a “given” in regard to this essay. It is that the citizens of the U.S. are demanding changes in the availability of medical care and that changes will come. This essay will discuss the present “players” in the field of medical care. It will give my opinions as how they will have to change their modus operondi. The players are:
These changes will not come about in one fell swoop, but will be made step-wise through extensive negotiations between the players.
Patients will have to adapt to the fact that changes will be made. They will have to see to it that different tiers of medical care are available. These tiers will be tailored to the diversity of our population. The changes will have to aggressively address one of the main problems of our medical system – its cost.
Over 90% of the physicians in the Milwaukee metropolitan area are now employees of hospital corporations who are unfairly designated as “nonprofit”.
In the Milwaukee metropolitan area all of the surviving hospitals are owned by large corporations that are erroneously designated as nonprofit. When and if the “TRUTH IN BILLING” suggestions made in this essay are put into place hospitals and many insurance companies will take “a big hit”. Here the government will have to step in as will wealthy contributors. As mentioned before it is patently unfair to have sick patients and their insurers pay for hospital expansions, advertising, often inflated corporate salaries, research, and medical educations.
4. Pharmaceutical industries
Here again, some hard fought for changes are in order. First, the “old saw” that huge profits are necessary for the pharmaceutical industries to be able to develop life saving drugs must be eliminated.
The truth of this matter is that the main thrust of the efforts of drug companies now is an attempt to develop “look alike and act alike” substitutes for their most profitable drugs so that they can be marketed under patents when these drugs are replaced by generics. This will allow them to continue to charge the prices that they obtained before generic development happened.
5. Insurance companies
Just as financial institutions in our country have had to change their ways due to the mortgage debacle insurance companies will have to change their modus operondi, as well. No longer will they be able to concentrate on the “creams” of the insurance market by refusing to insure individuals with prior diseases. I am sure that insurance companies will adapt to the new realities of their market that will emerge. They will be helped in these changes when the “truth in billing” concept will be negotiated between them and hospital corporations.
A too cozy relationship between the medical journals, pharmaceutical companies, government agencies and state and national medical societies will have to be carefully examined. Details regarding the conflicts of interest between there important players are outside the realm of this essay. When one realizes that a state medical society is the entrepreneur that profits from its sponsoring and selling the most influential medical journal in the country and that one of the lucrative businesses of this journal is to publish the official papers of the government agencies a problem of conflicts of interest is apparent. The other conflict of interest in their endeavor is their dependence on revenue from the advertisements of the pharmaceutical industry.
All but a few of our great universities are now suffering in regard to what they do
best, teaching and research, because our present administration feels that much of their research violates the philosophical feelings of our citizens.
It is not within the realm of this essay to dwell on changes in government agencies
and the judiciary. They will undoubtedly be involved in the implementation of the changes that have been discussed in this essay. As with everything else discussed herein, changes will be hard fought. What eventually happens will depend, in a great degree, on the involvement of the public and with their communication with their elected representatives. It seems that many of the changes that will have to be made under a universal health care system will have to undergo judicial review.
These departments will be important because of the enormous amount of data that are now required to be made available to many diverse parties.
From the physicians’ and patients’ points of view, much of these data are unnecessary. One of the biggest problems in this regard is the present requirement of third party payees that all a physician does or orders must have written indications. Part of this requirement is being met by many physicians by using a “boiler plate” computer program that produces a record of the type required by a third year medical student. This tremendous output of meaningless paper would be unnecessary if the third party payee would trust the physicians in regard to what they think is necessary for the patient. If this trust could be developed, the medical record would consist of one-half page dictation in which the physicians describe patients’ situations, medications, treatments and plans. Details regarding operative notes, laboratory reports, and taped copies of x-ray studies can be kept, as they are now, in the archives of the departments in which they are done and can reviewed on-line as necessary. Interested parties could ask for retrieval of these data by request to the department concerned. The cost of doing this would be met savings incurred in the production of a single, helpful medical record that would be available in the medical record department’s computer.
Details regarding this much needed simplification of medical record keeping will be worked out by a task force representing the country’s medical record departments.
At this point, interested readers will be asking themselves, “How can the ideas in this pie in the sky essay be implemented?” Fortunately, there is a manual available that can be used to guide the players involved with this endeavor. It is presented in a book by Dennis Ross entitled, “Statecraft-And How to Restore America’s Standing in the World”. Ross outlines in his book principles of negotiation and arbitration that can act as a guide for those responsible for developing a system of universal healthcare in the United States. These principles are listed at the end of this essay.
If the “players” discussed here will imagine themselves as entities that are trying to get their fair share of the money generated by the universal health care plan, they will find in this book a road map to follow in the negotiations and arbitrations that will be necessary to achieve their goals. The first action of the players will be to get together experienced experts in their field in a “think tank”. Their mission will be to come up with what they can and what they can not give up in negotiations with others concerned with universal health care. Their conclusions will be the cornerstones used in negotiations with the other healthcare players involved. The “think tank” participants will have to accept the fact that a time will come when they will be forced into accepting arbitration regarding some points. Here they will have to decide in advance what they can give up and not give up in arbitration. Then, hopefully, the players will arrive at a point that a “think tank” comprised of experts from all of the players can come up with a plan that will be acceptable to the members of legislature who will present legislation to Congress. At that point, more negotiations will be necessary between the two houses of Congress, in which, again, all concerned will have to decide how far they can go to get the legislation passed. For this to happen, all concerned will have to accept these facts and that the final plan will cost the players and the taxpayers money.
Finally- It is my dream that the next president will include in his acceptance speech the following:
“This is to share with all who are listening to this address that I have heard and accept the universal opinion of the American people that they want a Universal Health Care system. I want to share also that this program, to be successful, will cost a lot of money that will have to be provided by increased taxes.
Even though I am well aware that a proposal to increase taxes to provide Universal Health Care to all may well cost me the next election, in spite of that, my program will do just that, because I feel in my heart that it is in the best interest of all of us to approach Universal Health Care realistically.
Both presidential candidates have promised to implement a plan for universal health care and both have eloquently presented the case for this being done. However neither of them have told us how they think legislation to this effect should be developed. This is the reason for the presentation of this essay.
The principles of negotiation and mediation to follow in preparing universal health care legislation are presented in Ross’ book on Statecraft:
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