By Howard A. Green

  You’ll listen to me because I’m your doctor.  I only have your health interests in mind.  I have written this article without ‘prior authorization’ from any insurance companies.                  

There are some intuitively obvious services that the government runs more productively and efficiently than private for-profit enterprises.  For example, our armed forces and GI’s conquer and hold and protect territory more effectively and at a fraction of cost of private militias such as  Blackwater USA and the Crescent Security Corporations.  In addition, the government rules and regulations which our governments’ military adhere to insure an ethical cohesive fighting force compared to the unregulated for-profit corporate armies.  Our GI soldiers assigned to kitchen duty prepare and cook meals at a fraction of the cost of identically prepared meals from the private for-profit logistics divisions of the Halliburton or Kellog Brown and Root Corporations.  Government regulated public education in America such as the undergraduate and college systems of the City of New York and other large metropolises have for over a century produced more CEO's, doctors, lawyers, accountants, engineers, chemists, poets, philosophers and military officers than any private school system, and at a fraction of the cost compared to all the private schools in the country combined.  Take away the government grants, government tax breaks, and government sponsored free overseas labor from Americas top private Colleges and their classrooms and graduate programs would most likely shut down, no matter how large their private endowments.  The government run and regulated public school systems of Israel, India and China are churning out competent engineers, scientists and entrepreneurs at a quality and rate much greater than that of any collection of private schools in any country in the world.  These non-American people, highly educated by their government run school systems, have formed a new collective worldwide labor arbitrage system which is fueling the productivity of intercontinental private business.  The Marshall Plan, Interstate Highways, Space Program, Peace Corps, Colorado River Dams, National Institutes of Health and the GI Bill all demonstrate successful government run bureaucracies of their time.                                            

   In a similar fashion, our mammoth government-run health insurance company (Medicare) operates at a fraction of the cost of private insurance corporations such as Aetna, Cigna, United, Blue Shield Blue Cross, Kaiser Permanente and Humana.  Medicare, the government health insurance for the elderly uses only 1-2% of your dollar to achieve rates of morbidity (sickness) and mortality (death) among their patients which are identical to those of the private health insurance corporations.  However, private insurance corporate bureaucracies inefficiently siphon $500-$750 billion per year, or 25-30% of your hard earned dollars away from doctors, hospitals and patient care into the pockets of their executives, administrative employees, shareholders and politicians.  The recent stock option fraud perpetrated by the CEO of United Health Care demonstrates the negligent disdain the private insurance corporations have for physicians, hospitals, health care workers and patients.  Since their founding 40 years ago, private health maintenance insurance corporations have failed to deliver what their business plans always promise; lower rates of morbidity and mortality associated with low costs to the patients.  In fact most of the 1.25 million people who declare bankruptcy each year due to medical illness expenses had some health insurance coverage.  These health insurance companies are financially profitable for their shareholders and executives, but medically bankrupt for their patients. 

   Without their own reckless and negligent medical rationing, legal exemption from antitrust regulations that apply to every other industry, massive government subsidies, government protection from malpractice lawsuits, and a government ban on collective bargaining by physicians, the private health insurance corporate bureaucracies of Aetna, Cigna, United and Humana, and a thousand other health insurance companies of the health insurance industry would undoubted fail to exist.  Most elderly people who call themselves Republicans, and conservative physicians in this Country have recognized the efficacy of our government regulated Medicare health insurance corporation and have enrolled themselves and utilized this  Government run health insurance company for their own or their spouses medical needs (despite the shrill cries of socialized medicine from their leaders).  40+ years ago we heard these same shrill cries from organized medicine and Republicans concerning the establishment of Medicare.  After accepting trillions of dollars in Medicare Insurance payments over the ensuing 4 decades, one can only wonder why conservative physicians and patients still rally like Quixote against this clinically efficient and cost effective government run insurance product for the elderly.

The following 9 steps will simply suggest how, without the inefficiencies and burden to productivity of private insurance corporations, we can deliver efficient and effective comprehensive health care with great savings and no sacrifice of jobs.  In fact, we may be able to decrease morbidity and mortality in this Country with one coordinated system which cares for all Americans, and concurrently analyzes optimal diagnoses and treatment modalities through its integrated computerized billing system.  The savings incurred insuring all Americans through the more efficient Medicare system will benefit all citizens of our Country.

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9 Steps to Comprehensive Quality Health Care in America

1) Shut down the private health insurance corporations.                                                                                   

3)  Hire the now 1.25 million unemployed former private health insurance corporate bureaucrats to actually deliver and not inhibit health care by working in hospitals, doctors’ offices, clinics and nursing homes around our Country.  Demographically, the percentage of elderly Americans is rapidly increasing.   With every American now insured through Universal Medicare Insurance, real health care workers will be in desperate need.   For the first time in the brief but bloody history of managed care, these former private insurance corporation employees will actually touch and improve care for patients by working in physical therapy, nursing, home health care and other ancillary patient care capacities.   No longer will we have 1.25 million patients who are bankrupted each year due to medical illnesses which is equal to the number of bureaucrats previously employed by these companies.

4) Obtain by eminent domain (for the public good) the best of the intellectual property protected computer codes which the closed private insurance businesses previously used to monitor patient care and doctors utilization and performance.  Private health insurance companies have used these computer programs exclusively for the purpose of strong-arming their contracted health care providers into doing less for their patients and increasing the premium costs for sicker patients in order to achieve higher corporate profits by 10-20%.   Medicare on the other hand can use these same computer programs for the common good; to monitor, collect data and eventually improve the efficacy of diagnoses and the treatment of diseases and medical outcomes every time a doctor submits a bill. For example, wouldn't it be nice to know as a medical consumer (patient) which oncology groups in Boston, New York or Houston have the highest cure rates for stage III breast cancer or Stage II prostate cancer?  All those numbers currently exist in cancer registries nation wide and just need to be collected and honestly disseminated.   Currently, instead of medical data which delineates morbidity and mortality and outcome performance, the medical consumer when choosing an oncologist must rely on word of mouth, physician referrals or advertisements in the local papers or billboards which show photographs of smiling doctors in white coats who claim to be the ‘best’ doctors in town.  Solid medical outcome and prevention data would foster a beneficial marketplace capitalistic competition between physicians and hospitals based on quality which currently doesn’t exist due to the complete lack of outcome revelations by the private insurance and drug companies.   In addition to garnering invaluable instantaneous epidemiologic data on diagnoses and treatment of diseases based on severity and other variables, a strong Medicare based utilization review computer code would also allow Medicare to easily monitor doctors and hospitals who abuse a fee-for-service billing system. Any physician, institution or service found to fraudulently abuse the Medicare fee for service billing system after proper review and appeal should be dealt with severely through stiff penalties and loss of their Universal Medicare provider contract.                                                                                                                                                     

5) Freeze Medicare physician, hospital and ancillary services reimbursements at current levels. Adjust reimbursements for future care services yearly by Cost of Living increases, or in the event of a deflationary economy a decreases in doctor and hospital payments.  Ask any physician and they'll tell you they would accept current reimbursement rates with COLA over the current mysterious illogical fee adjustment system of Medicare, or the physician population density political reimbursement formula used by most private insurance corporations.  Two tiered medical systems separating the “haves and have not’s” of society have and will always exist. Therefore, we must allow physicians to practice medicine without enrolling in or accepting the Universal Medicare reimbursement.  With private medical insurance no longer available, and no performance based evidence for improved morbidity and mortality among their private for-pay patients, these extraordinarily expensive private ‘VIP’ practices will be limited.                                                                                                                                                        

6) Close down the Part D government subsidizes for drug and insurance companies, and allow Medicare, much like the current Veterans Administration System and every other private health insurance company and government health care system around the world, to bid on medications from pharmaceutical corporations for its Medicare drug formulary.  Every physician recognizes that we don’t need a choice of a dozen redundant drugs in each pharmaceutical category.  For example, we need only 2-3 statins for cholesterol, a handful of antibiotics for infections,  2 beta blockers for hypertension, and a few pain killers.   Once the Government bids on pharmaceuticals for the Medicare Corporation formulary, micro economics will force prices to massively decrease to levels identical to that which all the other people of the world outside of America are paying for the same medicines.  Since it has not effectively decreased morbidity or mortality in this Country, and only wastes money, we should also prohibit pharmaceutical companies and their workers from contributing to political campaigns or buying commercials on the public airways.  We need to also prohibit the current practice whereby your local  pharmacy and pharmacist sells your confidential private medical diagnoses and your doctors private prescribing drug information to pharmaceutical companies so the pharmaceutical companies in-turn can directly pressure-market physicians.  Prohibit pharmaceutical companies from contributing to organized medicine societies, colleges or associations because the doctors can’t rely on soft bribes or free lunches to prescribe what’s best for their patients.  Prevent pharmaceutical representatives from visiting doctors’ offices or hospital pharmacies directly. Allow delivery of Medicare formulary approved sample medications for patients to physicians’ offices via post office mail only.  Allow pharmaceutical companies to market products to physicians only via peer reviewed publications delivered by email or snail mail.                                                                                                                                                          

7)   With some of the savings incurred from closing the private insurance corporations and paying less for drugs, have the American government fully fund the National Institutes of Health (NIH) and the National Cancer Institute (NCI) and Small Business Innovative Research (SBIR) programs.  Emphasis should be placed on basic bench research carried out at not-for-profit American Institutions which employ or utilize a majority of American Citizens in their laboratories and clinics. Too often American Universities rely on free overseas labor to conduct bench research.  Clinical trials should emphasize new drugs and devices which have promise to significantly decrease morbidity and mortality for any disease, including orphan diseases.   Since a large percentage of private funding for drug and device studies will originate in the expanding financial liquidity and innovations and patients of the emerging developing world, we should allow the FDA to utilize research data obtained by reproduced laboratory and clinical studies performed overseas as well as in this country. Corruption of honest academics should be curtailed.   Force all investigators to release reproduced publicly funded scientific data for all scientists to review on the internet via the Freedom of Information act (The Senator Shelby® Amendment).  Prohibit rights of first refusal on scientific data for private companies performing research in non-for profit institutions which receive public funding. Any rights to profits obtained from intellectual property and patents invented with combined funding from government and private sources should be split fairly among the contributing government institutions and any other private corporations funding the research, as well as with the individual inventor.  Prevent organized medicine societies, associations or colleges from contributing to political campaigns since campaign donations have no relevance for physician performance or patient morbidity or mortality.                                                                                                                                           

8) Offer physicians the same legal protection from malpractice lawsuits which have been established for commercial health insurance corporations during the last 3 decades.  This will allow family practitioners and internists to fulfill their role as primary care physicians efficiently and productively tackling dynamic illnesses without prematurely referring their sicker patients without medical benefit to expensive specialists.  Limiting med mal lawsuits against physicians and hospitals will also allow doctors and hospitals to use the national EMR and outcome data for the common good via peer review, thereby improving underperforming hospitals, doctors and therapists instead of simply suing their scrubs off.       

   Lastly, some argue that Universal Government run health care in America will result in delays in diagnosis and treatment similar to those reported for some in Britain and Canada.  One can not simply compare the massive extremely functional Medicare insurance based infrastructure which effectively and seamlessly delivers private health care to tens of millions of the most elderly, sick and disabled people each year in the USA to the government run and owned socialized health care systems of Canada and Britain, France, Switzerland, Netherlands, Scandinavia, and Israel, where doctors and hospitals are employed and owned directly by the government.  We already spend twice as much as Canada per capita on health care, and have more doctor’s and specialists per capita, four times the MRI machines and lower hospital occupancy rates than Canada, so we’re off to a good start.  We can use Canada’s most recent analysis and correction of longer waiting times for certain elective procedures to avoid the same initial problems in America. Canadians have largely corrected the patient waiting time for elective procedures.  However, Americans can only boast that we rush to the grave several years younger than the average Canadian citizen.  America, for the last 40 years, thanks to the government run health insurance corporation-Medicare, has built an incredibly dense and fluid public insurance system involving almost all private doctors’ offices, private hospitals, private clinics and private ancillary services.  The Medicare insurance system dwarfs in breadth and actual private practitioners and efficacy the lesser insurance systems established in all other countries including Canada. The billing and reimbursement bureaucracy for private health care providers contracted with Medicare Insurance is already relatively streamlined and efficiently centralized in America thanks to 40 years of private physician, private hospitals and government cooperation. Those who argue that putting all citizens on Medicare insurance will be disruptive should remember that 4 decades ago we enrolled every elderly citizen in America in Medicare insurance in a period of just 9 months without the assistance of computers.  I doubt that the 50 million uninsured and 100 million under insured citizens in America will think private care coverage under a single payer national health insurance would be disruptive. While American doctors are routinely terminated from private insurance company contracts in order to enhance insurance Co. profitability, Medicare insurance almost never terminates contracts of these same ethical and competent private physicians.

   We all know that the medically bankrupt private health insurance corporations and medical malpractice lawsuit threats have caused many disheartened private physicians to quit practicing or downsize their practices in America.  A continuation and technological upgrading of our most fair Universal Medicare based health insurance Corporation based on the concepts outlined above would undoubtedly motivate those disenfranchised physicians to return to the profession and bright younger physicians to invigorate the field.   If patients, physicians and the Medicare Corporation continue to work together, without the deleterious interference of private for-profit health insurance corporations, malpractice threats and overt pharmaceutical marketing the future for American health care will be healthy indeed.  A continuation of the status-quo mixture of an enormous overhead, government subsidized private health maintenance insurance and pharmaceutical industry operating parallel to and within Medicare Insurance is wasteful, and will continue to provide no potential future health improvements for America.

 - > Dr. Green graduated from the George Washington University and obtained his medical degree from the Boston University School of Medicine.  He completed a 3 year residency in internal medicine at Thomas Jefferson University Hospital, Philadelphia, PA and is certified by the American Board of Internal Medicine.