In the opinion of many, including some courageous doctors, hospital administrators, and politicians, the present health care system needs comprehensive reform. It is not sustainable in it’s present form, nor curable with adhesive bandages and aspirin. Nor is it morally defensible to discourage deny care to the 7 million uninsured and the many underinsured in California. Because of recent comparative studies (see www.healthcareoptions.ca.gov) we have a better idea of the resulting cost (or savings) and impact on quality of various reforms. The following is a vision of what sustainable system would look like in California.

Simplicity:

First and foremost, the system would be simple to run, simple to use, simple to understand.

There would be one very comprehensive package of benefits, better than any now available, making “choice” of competing plans or additional insurance unnecessary.

There would be one place for providers to send bills, and that place would pay promptly for the care provided. There would be no uncompensated services. A system of electronic billing would further simplify the process. Fair reimbursement would be negotiated by region, with adjustments for risk. Physicians in fee for service practice would bill for services. Hospitals and clinics would negotiate yearly budgets, making billing unnecessary.

It would be up to patients and the doctors of their choice to decide the course of treatment and the need for specialists.

The only criteria for eligibility would be residency. There would be one time enrollment, lost only if one moves out of state or dies. There would be no premiums, deductibles, co-pays or out of pocket expenses. Simplicity in administration saves an estimated $14 billion. A single purchaser of drugs and medical equipment saves $4 billion. Emphasizing primary care and prevention saves $3 billion.

Financing:

Where would the money come from to pay for this system?

Fairness:

The system would pay fair compensation to those who work in the system and to businesses which supply the needed drugs and equipment.

Taxes would be at fair and affordable rates for businesses and individuals.

Persons or businesses who can not or will not pay for insurance in our current system, shift the burden to those who do pay. In a fair system, businesses would be on a level playing field, have less turnover and a healthier work force. All persons would pay into the system, proportional to their ability.

In a fair system where everyone is paying in advance to pay for care when it needed, everyone must be assured reasonable access to treatment. That means fair distribution of physicians and facilities in both urban and rural areas.

Effectiveness:

Unnecessary or marginally effective treatment would be reduced. Alternative medicine, provided by licensed California providers, and proved to be effective, would be covered. Data would be collected to help determine which treatments were most effective. That information would then be disseminated to physicians.

Financial sustainability:

A crucial part would be a predictable budget. To avoid unnecessary oversupply, there would be planning to anticipate the cost of both patient care and capital expenditures for structures and equipment. To avoid unnecessary expense, the effectiveness of high tech treatment would be evaluated. Those interested in a thorough discussion of high tech medicine and cost/benefit might read “False Hope” by Daniel Callahan.

Financial sustainability also means controlling the growth of spending. We now balance the health budget by reducing access to or excluding altogether from health care, a large percentage of our population.

We could decide what we can afford, put an escalator for increased population and productivity, and ask that all of us live within our means.

Consumer and Provider Participation:

All must support the system, so all must feel their opinions will be seriously evaluated. Regional boards would be accessible to receive and evaluate those opinions.

Vision and Action

A sustainable health care system does not have to be just a vision. Many groups are working in both California and across the nation to make it a reality. In Washington, D.C., Rep. John Conyers of Michigan has introduced The United States National Health Insurance Act calling for a single payer health plan, publicly administered and privately delivered, like Medi Care. In California, a system similar to that described in the vision above, will be introduced into the legislature in February by Sen. Sheila Kuehl of Los Angeles. In the end, however, it rests with each one of us, if we agree with the vision, to do what we can to support the vision. Dreaming is not enough.

To find out more, call locally (805) 682- 5183, or see www.healthcareforall.org.