A Modest Health Care Reform Proposal

Most of me thinks that two health care reform options are most worthy:
1. Consumer-paid fee-for service with a spartan government-provided safety net for the poor. OR
2. A single-payer system.

But I met a primary care physician involved in health care reform planning whose views represent a more middle-of-the-road approach that seems a good balance between concern with quality and cost. So I invited him to summarize his key recommendations in 500 words and that if I thought the document was worth your reading, I'd post it.

Here it is. As always, comments are welcome.

Health Care Reform: Viewpoint from a Primary Care Perspective
by Michael Rosenblum, M.D.

There are three essential issues for health care reform in the United States

1) We need a uniform national digital health record--Many errors are made due to illegible handwritten entries in patient records.A majority of prescriptions are still written by hand, and a majority of outpatient medical records are written by hand. We could greatly improve the quality of care, and save a considerable amount of money, by having national standards for digital data entry and making all health care records accessible from any point of care in the nation. There are political barriers to instituting this policy. Proprietary electronic systems would have to yield to uniform national standards. There are concerns about the privacy of patient records. We need to overcome such obstacles and get health care into the digital age.

2) We need to re-emphasize primary care—In the United States we are culturally addicted to the latest technological advances. We spend a disproportionate amount of the health care dollar on the latest laser surgery and the latest high-tech drugs. To provide health care to all citizens, we need to train more primary care doctors like pediatricians and internists and family doctors. The importance of the primary care doctor in providing preventative care, and coordinating the patient’s journey through a complex system, cannot be overemphasized. Insurance reimbursement needs to be increased for primary care, and decreased for specialists if we are to achieve this goal.

3) We need to fix Medicare and Medicaid before establishing costly new federal programs—The Medicare “trust fund” is on the verge of insolvency. Medicaid (MediCal in California) reimburses doctors and hospitals typically at 20-30% of the current market rate, resulting in poor access for patients. Both of these programs need to repaired and reinvigorated. Fortunately, this can be achieved without creating vast new federal agencies and hiring hundreds of thousands of new federal employees, as would be needed for the new programs proposed by the administration and Congress. The infrastructure for these programs has been in place since the 1960s. We merely need to fund them and they can reach their full potential. For example, Medicaid could be made available to uninsured adults up with incomes up to 400% of the Federal Poverty Level, rather than the current 125%, to make a large proportion of currently uninsured adults eligible. There are huge political barriers to reforming Medicaid. For example, Medicaid uses a formulary of generic drugs, and there would be strong opposition from the pharmaceutical industry to increasing funding for this program. Funding for Medicaid is partly from the states, and they are pushing back on any increase in the program that would require them to fund more health care. Clearly, the federal government will have to shoulder the fiscal burden of Medicaid expansion, but this is cheap by comparison to setting up a whole new program.