A 12 Point Plan for Health Care Reform

As a former executive with a major health insurer in Wisconsin, I have thought for many years what I would do if I was asked to reform health care in the United States. In my role as a communicator and lobbyist for this organization, I've explored the points-of-view of providers,
insurers, legislators, regulators and patients. I've concluded that any reform legislation need not be 3,200 pages. There are plenty of "best practices" to explore and incorporate in any reform plan. Also, much of this need not be legislated. Just rely on the best resources of the private and public sectors in using common sense in attacking reform.

I don't think we need to "blowup" the current system. It does need work, and is not perfect by any means. My 12-point plan is based on years of observation of how the system works and how it could be improved. I've worked in upper management of a major health insurer and two of Wisconsin's larger hospitals. During the past 20 years, I've also consulted with many fine funders and providers of health care, and have been a patient myself. Some of my points may be considered unconventional, and not in the mainstream of thinking of current health insurers. For what it is worth, here are my thoughts.

First, revise medical liability laws to make them more realistic so more medical students are attracted to the primary care specialties of family practice, pediatrics and internal medicine.
Currently, malpractice insurance for these specialties is excessive, and may deter students from pursuing these specialties.

Second, to improve competition and lower prices, remove the current provision that we may only purchase health insurance licensed by the state in which we live. Set national standards for health insurance and let us purchase plans anywhere in the United States.

Third, self-insured (ERISA) plans do not have to include state mandated benefits, although many do. Let the individual or employer purchasers have the same freedom to select a plan free of some or all of the state's mandated benefits such as chiropractic, AODA, birthing services, acupunture, etc. Premium costs could be reduced substantially.

Fourth, go back to a community/age-rated system popular with some plans 30 or 40 years ago. Premiums would be based on the community's providers actual charges. Comparisons could be made to other communities' charges by employer and individual purchasers. These purchasers could put pressure on local providers to accept best practices and qualitiy initiatives from the lower-cost communities to reduce costs.

Fifth, insurers must remove the pre-existing condition provision and include that risk in the community/age rating system of determining premium. This could provide incentives for communities to initiate and support well city/community health programs aimed at reducing utilization.

Sixth, hospitals need to develop a better triage system for people, especially the uninsured, who present themselves for care at emergency rooms. Only true emergencies should be treated there. Work with all levels of government to set-up 24-hour clinics down the hall or next door to treat the non-emergent patients at a much reduced cost. Today the cost of care for these patients is often passed on to the people who have insurance, thus raising their premiums.

Seventh, many of our non-insured are illegal immigrants. Have the State Department explore ways to work with the offending countries who allow their citizens who enter our country illegally to take more fiscal responsibility for their lack of emigration enforcement. Perhaps a substanial reduction in foreign aid to those countries could be rerouted to help pay for illegal immigrant health care. This is a very controvertial area, so much thought needs to be considered in how to do this. The current system is not working.

Eighth, develop a better tax incentive program which encourages all individuals to purchase health insurance. Have the tax benefit based on the annual income of the health insurance purchasers, with better tax benefits for lower income individuals.

Ninth, develop premium lowering incentives for people who show marked improvement in their health like weight loss, lower blood pressure, blood sugar, smoking cessation. Do not continue to punish people for past health care sins with higher premiums if they make positive changes.

Tenth, another "must do" for reform is the development of an easily transportable and easily updated electronic medical record system. This alone, could save hundreds of millions of dollars in duplicative or unnecessary tests each year. (A friend of mine is in the process of trying to patent and market these flash drive-type devices for your keychain or in a credit card format).

Eleventh, as a condition of getting health care coverage, each individual should have to register his or her advanced directives for end stage of life health care. The family anxiety and waste in the area are staggering. This would go a long way to provide ethical health care in the final stages of a person's life.

Twelfth, take personal responsibility for your own health and the health of your loved ones.
The resources are all around you. Take advantage of them and you will lead a longer, healthier and happier life.

Alan L. Gaudynski