America’s health care system is broken and no longer works.  Many practicing physicians are unhappy with the way insurance companies control medicine.  Most patients are unsatisfied with the benefits they receive from the health insurance companies and with the lack of choice they have in who cares for them.  Patients are frustrated with the exorbitant cost of prescription medicine.  They wonder why this system often doesn’t allow them to receive the exact meds their doctor feels are best for them.

Any proposal to completely redo the health care system in the United States must address these problems and make it possible once again for small businesses to cover health care costs for their employees. Here are twelve suggested steps that our country should take to make our health care system great again.

First, everyone from the poor to the wealthy must have health insurance.  No one should die because of lack of finances, and preventive medicine should be available to all.  Second, insurance has to be affordable, and no individual should go bankrupt due to health care costs.

Third, we propose that the federal government assume the role as a single party payer.  A possible start to fund this system would be for each employed person to pay 5 to 10 percent of their previous year’s income for health insurance on a sliding scale.  People who make less than $20,000 would be excluded from payment and receive charitable care.  Those with annual incomes of over $20,000, would pay 5 percent of their previous year’s income as a tax to the government.  The amount of payment would go up to a maximum of 10 percent for those earning over $500,000.  Everyone would have the same insurance and benefits.  Age and income would no longer determine what health care you receive.  Those over the age of 65 who are currently on Medicare would be put back into the pool of paying this tax based on their previous year’s income.

Fourth, the insurance needs to be attractive to doctors.  Currently, the health insurance companies hold the upper hand, telling doctors how to practice medicine and what they are going to get paid, an amount that decreases yearly.  Doctors want their reimbursement to be commensurate with their education, training, workload and overall risks inherent in their chosen health care profession.

Fifth, build incentives for the drug companies.  There should be a cap on the retail cost that consumers pay for prescription drugs.  Allowing the pharmaceutical companies to have longer times to keep their drug patents may sustain the life span of products before generic knock-offs are produced. This may be one bargaining tool to eventually lowering the drugs’ cost to the consumer.

Sixth, we need to create a plan that completely eradicates health insurance companies and gets rid of this unnecessary and harmful costly middleman.  The cost of medicine has increased over time, partly due to new technology and better drugs, but also due to the colossus of health insurance companies.

Seventh, a select number of hospitals should be set up as Centers of Excellence where certain higher-end procedures such as brain surgery, heart surgery, joint replacement surgery, and transplant surgery are performed.  These centers would be chosen on the basis of best patient outcomes and lowest cost.  By selecting a few hospitals in each state and equipping them with the best surgeons and support staff, patients would have the best opportunity to have a successful surgery, and the complication rate which drives up cost would be reduced dramatically.

Number eight on my plan is that all doctors would return to seeing Medicare patients.  Reimbursement and punitive regulations associated with Medicare have driven most doctors away from Medicare patients. If we had one health insurance plan for all Americans, we could stipulate that the payments to doctors would be the same whether the patient was 25 or 85 years old. We need a plan that ensures seniors receive health insurance equal to the rest of society. Seniors should contribute to insurance as long as their income keeps them eligible.

Number nine concerns catastrophic health events such as organ transplants.  We need a plan that funds catastrophic insurance through revenue generated from taxes on cigarettes, alcohol, and high-sugar beverages.  We could establish a maximum limit that a consumer would pay on a catastrophic health event (such as $50,000 with the rest of the payment covered by these “vice” taxes).

Number ten, the insurance has to be portable so that it can be used in any state since all Americans would have the same plan.

Number eleven, there can be no revocation of insurance due to pre-existing conditions.  Our health care pool is our entire country.  No one must be left behind regardless of their illness.

Finally, number twelve, there has to be insurance for those capable of paying nothing – either the very poor who make less than $20,000 a year, or the mentally or physically disabled who are unable to contribute their share to their health care.

This 12-step plan is woven from my 27 years as a practicing gastroenterologist. People feel that the health care system has failed them and want it to change.  The costs are astronomical, the medications are unaffordable, and all too often doctors don’t want to see them because of their age.  In my proposed plan, the patient costs would be fixed, there would be a cap on drug costs, and no one would be denied care due to age or pre-existing condition.  We are America, the world’s greatest country, yet we can only say our health care is as good as that offered to our poorest sickest citizen.  Under my proposed plan, we can honestly say that even the most underprivileged are afforded the best health care our country has to offer.

Michael F. Weisberg is a gastroenterologist and author of The Hospitalist.

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