Features of the Future US Health Care System

QUESTION:  Why is the patient's freedom of choice for clinicians one of EINO's health care principles suggested as important for state activists to consider?

We should be concerned not only about choice of physician but also with people's choice of hospital, nursing home, home care agency, hospice, and of other clinicians such as nurse practitioners, primary nurses, psychologists and social workers. Under the present market-driven models the patient is usually told which hospital he or she may go to, what nursing home they can recover in, what psychologist they can see, which home care agency they must sign up with and so forth. The comfort and convenience of patients and families is sacrificed, so that the insurer can cut better deals with clinicians and health care facilities. 

Consider how choice of insurer has been restricted. According to one recent study, 91% of firms with fewer than ten employees, 80% of most small firms and 47% of large firms offered only one plan. The remainder may offer two or three. However, even when employees are able to choose from several plans, this choice may be more apparent than real because increased price competition has led all health plans to reduce care to the lowest common denominator.

QUESTION:  Are EINO and its allied organizations against regulation and control of physicians?

The public ought to be asking who should be regulating clinicians, and in whose interest? Clinical practice must be guided so that the most effective treatments are offered in an efficient manner. But this guidance must be motivated by the desire to serve patients not to increase profits for related industries. Therefore, we believe that any savings generated from clinical and technological innovation must be recycled into expanding access, and encouraging innovation in practice to enhance overall quality. But if we're looking at ways to improve health services to our population maybe we should be considering cutting off the growth of individuals hired specifically to create greater obstacles to people receiving the care they need?

This is not what is happening today. In fact, quite the opposite is occurring. Access is not only shrinking for the uninsured, it is also shrinking for those who are supposedly well-insured. If that is, they have the misfortune to get sick. Project EINO is all for better regulatory oversight in the public's interest, not just with physicians though. Why should current government programs cede to the pharmaceutical industry un-negotiated prices, set by the industry, when we know that prices can be controlled effectively through buying in bulk and negotiation? Surely, in this way also we are looking for fairness, openess and government oversight (protecting the public's interest) as a feature of an improved health care system.

QUESTION:  Why is a strengthened public health system belong as part of a new UHC system as suggested in EINO's health care principles? 

A strengthened, better financed public health effort will save many many times its cost.  In a UHC system this savings will accrue to the overall health budget making it even more affordable to cover everyone in the nation well. One recent example of this was studied and reported in late 2005 with respect to a more complete and rationalized system for child vaccination than that which occurs rather haphazardly at present, considering all needed vaccines. Estimating only part of the benefit (not trying to include loss of friends, family and productivity to society), the authors found a savings of about $50 billion over 5 years. That's health care expenditure we already make which could go towards covering more Americans for needed health care. Independently other researchers have estimated that up to 800,000 deaths in the USA each year could be prevented (lives significantly prolonged) through public health interventions even in just 3 areas.  

QUESTION:  Who could we possibly trust to regulate the numbers of health care providers, if this is not to be controlled by the market and efficiency of delivery?

It is impossible to imagine that such things could be regulated any more poorly than they are presently.  With "nursing shortages" rampant coast to coast (search news archives with "nursing shortage") and the best nurses leaving practice, patients are finding that the nurses even on the most critical hospital floors are too busy to help them consistently as they need.  Why are nurses hard to find?  Clearly regulation of the health system by maximum profit extractable is the worst idea any country has tried.  And clearly somehow our future system would have to regulate conditions and the reasonable number of needed health professionals.

QUESTION:  How would a UHC system assure anyone of quality health care?  Wouldn't UHC just result in a two-tier system with poor quality care for all low and middle income people?

The first of EINO's three essential features for a new UHC system is that it shall provide everyone with "high quality health care services and products", we will not accept a system providing most people with a substandard system.  To achieve and maintain a high quality care sytem, either everyone must be in the same public system (even the very rich and powerful, even our legislators and highest officials), or the public system must be carefully maintained with adequate funding.  We have the resources already to fund the system adequately for high quality care. Assuring the nation of high quality care would be an essential feature of any EINO-endorsed health care system. The USA's evaluation by the set standards of national health would have to improve, so that we could truly become a leading democracy once more.    These include such measurements as infant mortality ^{see also} and life expectancy, but also should include measurements of eliminating racial and ethnic disparities.

To maintain adequate funding it would be best, we believe, to make explicit the public's "Right to Health Care".  This then becomes a right, like primary education for our children, that Americans will all expect, cherish and defend.  We will have a basis to demonstrate and mobilize to keep the funding adequate. 

QUESTION:  What would the most striking changes in features of a UHC "Everybody In, Nobody Out" system?

The most striking characteristic to change would, of course, be the processes by which design features would change and evolve, i.e. according to the public good rather than according to which favored industries were to be allowed extraction of egregious sums without corresponding contributions to the public's health care. New programs could not be introduced which compound already outrageous administrative costs with additional waste of public funds.

It would no longer be "system operations as usual" to reward a handful of top executives in health insurance $600 MIL extra in "merger bonuses" in a single year for engineering a system with less control over costs and premiums. Such money would clearly be seen for what it is, extraction from the public's health care dollars of money that should go towards our care. Nor would it be fine that the revolving door continues swinging (at $600 MIL a swing) between public officials supervising new health care systems and consulting for the industrial beneficiaries.   Nor would it be okay that an army of 1300 lobbyists fashion a new prescription drug law, even if they are paid nearly $1 BIL over the preceding years by the pharmaceutical industry. Nor that the party in power in DC reward the pharmaceutical industry with an additional $22 BIL for nothing at all.

It would not be okay that a leading "supposed consumer organization" publicize a new prescription drug law for a corrupt adminsitration, only later to the public's realization that this organization makes 40% of its income from insurance royalties (including new private drug plans). Nor that the public awaits in horror (2006) for the next GOP president to do for health care what GW Bush and Cheney did for US oil and energy (with some help from close friends like Ken Lay and oil business buddies).