Jack E. Lohman: Health care for all: We need only the will

By Jack E. Lohman
November 16, 2006

There are many areas that must and can be fixed, but simplicity is the key. Simple is less expensive and simple doesn't break. And the simplest system already exists; it's called Medicare-for-all. We don't need complicated insurance pools or anything else; we need to provide health care, and here's the best way:

• Single-payer delivery system: The simplicity of a Medicare-for-all system can provide health care to 100 percent of our population for the same money we are paying for 85 percent coverage today. Means-tested co-pays will help keep costs to a minimum. Transfer all Medicaid and BadgerCare patients into this single system.

Alternatively, find a mechanism to expand the medical systems for the military and veterans to replace our private sector health care needs.

• Who should pay for the health care system? The taxpayers rather than employers, though some phase-in will be necessary. We are paying now when employers add their costs to the price of their products and we reimburse them at the cash register. By eliminating the costly middlemen, we can cut the costs by a minimum of 30 percent.

We could help fund the system with a surcharge added to criminal fines and by diverting punitive damages from malpractice awards. A tax-free charitable endowment can also be established.

• Medical education: We could increase the availability of doctors and nurses by providing free college education to high school students who both rank in the top 10 percent of SAT scores and maintain college grades of A or B. Give those in the C range some debt assistance.

The better students should be allowed into the specialties and the poorer students required to serve longer internships and perhaps even be limited to lower level positions that cannot endanger patients.

• Universal IT: We must maintain all patient, doctor and hospital information in a highly secure universal health database. Start with the patient answering a lengthy on-screen health questionnaire, add the physician's diagnosis and treatment. The system can provide the physician a list of treatments provided by other physicians around the country and under the same circumstances, and alert the physician when medications are incorrect or will interact with other meds the patient is on. This will reduce practice variations, medical and prescription errors, and give the patient cost and quality of treatment transparency of the physician.

• Certificate of Need: We should require all major hospital expansions and purchases of high-tech equipment to be approved by a (re-established) CON board of review.

• Physician self-referrals: We should prohibit payment for tests using their own high-tech equipment ordered by physicians and clinics (because the tests become profit-making cash cows that result in over-ordering and wasteful spending under the current fee-for-service structure). Referring patient testing to well-equipped hospitals or independent labs has always worked well.

• Medical malpractice: We should replace the 12-person jury system on malpractice cases with a three-person panel staffed by retired (or at least non-conflicted) physicians and nurses. If guilt is determined, all awards should be set by this panel. Economic damages shall consist of the patient's out-of-pocket expenses, reasonable pain and suffering, and reasonable legal costs.

If punitive damages are to apply, they should not go to the patient, who has already received economic damages, but instead paid into the universal health care fund.

So now we will learn whether Democrats and Republicans can work together in the best interest of their constituents, or whether the $1.4 million in yearly campaign money from health care interests carries greater weight.