Before mowing on a tasty Father’s Day dinner of BBQ spareribs, grilled corn and summer salad, the BlueDog posed the following question to his own father and brother-in-law, Mayo and Cleveland Clinic-trained Central Valley physicians with a combined 103-years of experience in American medicine:
If you could wave a wand and fix the healthcare system in the United States, what would you do?
Here is what they said. Bear in mind, these are fiercely opinionated and incredibly intelligent, ethical doctors who entered medicine as a calling and out of a love for medicine. They are on the far downside of their careers. They have no turf they need to protect. They aren’t being paid to defend anyone’s position, including the AMA’s. [“Too many doctors nowadays think MD stands for much dough,” my brother-in-law even lamented.]. They just speak bluntly, as doctors often do, about how things should be. It’s about as pure a viewpoint you can get these days. You might be surprised at their views:
(1) The delivery system should be a single payer system -think Medicare for everyone – but run by a quasi-governmental organization such as the Federal Reserve, Tennessee Valley Authority or Base Closure Commission with strong input from respected professionals and medical economists and a minimum number of politicians.
(2) Cost containment is key and depends on properly placed provider incentives for efficiency – that is, (a) budgets negotiated with large physician run, cohesive, integrated multispecialty medical groups with strong leadership and experience in utilization review and quality assessment (there are many now in existence – Mayo’s, Cleveland Clinic, Sutter, Kaiser, etc., most participating in HMOS), (b) avoid physician-owned facilities and (c) negotiate a national drug formulary.
(3) Evidence-based medicine. Define quality using the most recent information from data-based medical studies. Require, as much as possible, that treatments and diagnostic procedures are in line with current standards as determined by professionals.
(4) Systems should be funded by a pay-as-you-go, transparent, fund from visible personal and business taxes, which over time would replace all or most of present private premiums. This should not be funded from general tax revenue. A reasonable administrative cost allowed, perhaps not over 5 percent. Commercial insurance would remain only is a supplemental form, covering deductibles and co-pays as is now allowed in Medicare.
(5) A federal cap on pain-and-suffering awards for malpractice. Experience in several states, including California suggests it lowers malpractice premiums.
When the BlueDog’s father speaks to community groups and seniors, he defines socialized medicine for them and asks if they are in favor of it. No hands are raised. But when he asks how many like Medicare, all hands go up. “This is socialized medicine,” he tells them. “And it basically works.”
So consider the source of these reforms. Two big-brained guys who have committed their lives to medicine and medical economics. No axes to grind. No skin in the game anymore. Just a passionate wish for medicine to be much more than it is today . . . in the richest nation on earth.