Mospaw's post on US Healthcare in the America's form got me to thinking. The current "system" of healthcare available in the US is a hodgepodge of private and publicly funded insurerers, hospitals, providers, etc. It has developed over the years in reaction to political pressure, changing business practices, and a variety of other factors. Before we attempt to figure out to fix something that is so badly broken, maybe we need to take a step back, examine the wreckage, and try to decide how it should look before we break out the tools. Here are some thoughts on what a nationwide healthcare system in the US could look like: <u>Point 1</u> The system must be oriented toward prevention and early detection. It is far cheaper and more effective to prevent illness than it is to treat it. This means that all children are afforded immunizations, well-baby checkups, eye and dental care, through the age of 18, regardless of the family's ability to pay for such care. Nutrition programs must be included in this coverage, as well. Studies have shown that children who are adequately fed have fewer health problems later in life and are more likely to be successful in school. Besides offering children the basic preventive care to get them started out right, adults must be offered weight management programs, smoking cessation programs, incentives to participate in regular exercise programs, and information and education on avoiding health risks. <u>Point 2</u> The system must be market-driven. A free economic environment is one that will foster growth and research. It will reward skilled practictioners and facilities. It will provide incentives for people to enter the medical profession. A market-driven health care system can, if managed properly, create an environment in which various entities are competing to offer the highest level of care at the lowest possible cost. It works in other industries, including service industries; there is no reason it cannot be made to work in the health care industry. <u>Point 3</u> A health care system must be based on medical necessity. Simply put, that means that doctors make the decisions regarding a patient's treatment plan, in consultation with the patient and relevant specialists. Additionally, once a patient's physician has developed a plan of care, everthing within that plan is automatically covered. No "unreimbursed expenditures" will be incurred by the patient. By all means, a system of peer review should be implemented for non-standard plans, or for ones that could incur extraordinary costs. Such peer review, however, must be limited to other medical professionals whose sole responsibility is merely to judge whether or not the patient's physician has made reasonable and prudent decisions regarding the plan of care and that no other feasible, medically viable alternatives exist. <u>Point 4</u> This health care system must be managed for quality. Credentialing and ongoing training for all health care professionals should be mandatory. All such professionals should only be required to work reasonable shifts, no more than 12 consecutive hours per day, or 24 consecutive hours every three days. A nationwide, mandatory system of supervised probation with the potential for de-licensing/de-credentialing must be instituted to monitor and correct the performance of poorly-performing medical professionals. <u>Point 5</u> A nationwide healthcare system must foster and encourage basic medical research and development. So-called "orphan drugs" and highly specialized apparatus should be subsidized in some fashion by the government. Corporations performing research should be able to write off reasonable costs associated with "dead ends". At the same time, prescription drug prices must come down. This could be done by extending the time period a company holds on a drug patent, so that a greater amount of time is available to recoup the initial investment and make a profit; or, the government could be the sole-source purchaser of drugs, negotiating directly with the manufacturers to gain the cheaper prices available when mass quantities are involved. <u>Point 6</u> This system must be single-payor. Vast amounts of waste and duplication are built in to the current health care claims processing systems. Most practices and hospitals employ any number of people whose sole responsibility is to coordinate claims payments between various plans. One payor, one standard set of transactions, with incentives to automate and process those transactions electronically. <u>Point 7</u> Lastly, this system must be universally available. Office co-pays must be large enough to discourage frivolous use of the system, but small enough as not to pose a burden. Premiums should be based on ability to pay and adjusted according to the need for prescription medications. Annual deductibles should be non-existent for illness-related treatment, and reasonable to cover injury-related treatment. Those are my thoughts on the form a nationwide healthcare system could take. So, what have I left out?