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A Prescription for a Better Health Care System

Health care belongs in the realm of public service, not the private for-profit sector. It should be a societal obligation to provide good medical care to all, regardless of social or economic circumstances This is the ethical mandate of the medical profession, historically dedicated, as it should be, to the best egalitarian principles.

Even the wealthy among us cannot claim to be truly wealthy if our neighbors or their children suffer from lack of access to proper medical care or the prospect of bankruptcy because of illness.

The "Affordable Care Act" of the Obama administration correctly addresses the element of universal access and coverage. However, the ACA does not correct the poorly constructed elements of health care funding that are still in place.

There are, therefore, both ethical and economic advantages to the following system that should replace the ACA. The key element of what I propose is that essentially all funding for universal health care should derive from individual income taxes, rather than from contributions from employers and other sources.

What I propose is not a "socialized medicine" entity, as it does not interfere with the choices of either medical providers or patients. All may continue to work where they prefer and to provide or obtain services to or from whom they choose. (A true "socialized medicine" system, on the other hand, mandates where physicians must work and who their patients are. Patients, in turn, must see their assigned physicians. No one advocates this for the U.S. In other words, "Single Payer" is not "Single Provider.")

Here, then, is what I suggest:

• A "single payer" — i.e. a truly "national" health care system, funded entirely by individual income taxes. In other words, the IRS collects each individual's payment into the national health care system. No one, therefore, can opt out, as everyone has to pay income tax.

• Each person to be responsible for a significantly high yearly deductible to discourage patients and physicians from frivolous over-utilization of medical resources.

• All taxes and deductibles graduated, based on income, just as are other taxes.

• No employer involvement in health care.

• No private medical insurance company involvement. These entities would simply disappear, or change their function to solely administration of the system.

• Fee for service compensation still to apply, with 100 percent of fees paid by the National Health Care system directly to physicians and hospitals.

• No deductibles or co-pays withheld to physicians, but collected as part of the individual income tax owed.

• Fees paid based on negotiated rates to physicians, clinics, medical organizations and hospitals; fee schedules updated and revised as needed every several years.

• Input on fees by multi-disciplinary committees of physicians, government agencies and other health care organizations.

• Preferred method of compensation to physicians to be yearly salary, based on the excellence and experience of the physicians.

• No incentives to do unnecessary tests, procedures or visits.

To the extent that businesses would no longer have to deal with health care matters or the medical expenses of their employees, businesses would be obligated to raise salaries/wages of their employees. This would largely offset the higher income taxes that the employees would pay for the national health care system. Businesses and entrepreneurs would then be able to concentrate on new ideas, business expansion and more efficient goods and services. The national economy would benefit infinitely, as would the overall psyche of a nation that is currently devastated by its bizarre, awful and irrational health care system.

Another alternative is to set up not-for-profit, physician-run HMOs that would compete for patients. But a national health care system still would collect all money by the individual income tax method and pay directly to the HMOs, based on the population numbers served.

Many enlightened countries use the above concepts, and provide excellent medical care that is actually better than that in the U.S. Among these are The Netherlands, Israel, Sweden, Finland, Denmark, Canada and more.

Essentially all top U.S. academic centers, their physicians and the medical literature advocate the above measures.

— Eli Goodman, MD, is a Springfield-based internal medicine physician, and serves as medical consultant to several organizations.

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