A Radical Prescription

Dr. Martin Weiss is an assistant clinical professor of internal medicine at the David Geffen School of Medicine at UCLA.  In 2008, he was recognized as author of the year by the American Journal of Public Health.”

Drs. Weiss have laid out a plan that directly addresses the the current system, what’s wrong with it, and how to fix the problem through re-engineering the processes towards the benefit of the patient.  It looks at fixing the system, rather than re-productizing the current system which is what the current Administration and Congress is trying to do.

I encourage each and everyone of you to read Radical Prescription, to pass it on to others, to discuss this plan. Keep in mind the following questions when reading and discussing:

• Does this plan address and fix the problems of our current system?
• Does this plan give control back to the patient and doctor relationship where it has always belonged?
• Does this plan reduce cost and waste permanently?
• Will I enjoy an even higher quality of care and services delivered?
• Does this plan limit the role of government in my life?

We summarize our proposals here. The goal is to markedly reduce health care costs, without causing any significant detriment to the quality of care. These are to be taken as broad policy outlines, and not a complete and detailed plan.

I. Reduce the cost of labor

A. Physicians

1. Remove four years of college from pre-medical education.
2. Replace those four years with three years of public service for underserved populations, to be performed following completion of medical training.

B. Non-physicians

1. Expansion of some primary-care delivery (hypertension, etc.) to medically trained non-physicians, such as pharmacists.
2. Colonoscopies, etc., to be performed by technicians.
3. Basic dental care to be provided by dental technicians

II. Reduce wasted labor. Establish an alternative to current tort-based medical practice

A. Malpractice

1. Remove malpractice from the tort system.
2. Decouple malpractice determinations from malpractice awards.
3. Single-payer malpractice insurance through tax on physician incomes.

B. Documentation: terminate the legal presumption that if it wasn’t documented it wasn’t done.

C. If patients desire continued outside oversight and tort control of their health care, rather than patient-physician centered care, they are free to elect to do so, but must pay in premiums the extra costs that format of care requires.

III. Business

A. Insurance

We propose mandated catastrophic insurance for all (see below, under Delivery of Health Care), but should the current insurance structure remain in place we propose the following:

1. Terminate all government preferences and subsidies for managed care.
2. GAO to investigate specifically where money goes in “administrative costs.
3. Terminate tax-free status of employer-based insurance.
4. Terminate prohibition against purchasing insurance out-of-state.
5. Regulate coverage
   • Restrict right of rescission
   • Regulate “usual and customary charges.”
   • Prohibit non-payment of claims.
   • Restrict “pre-existing” illness denial to conditions that significantly impact morbidity and mortality.
   • Prohibit denial of treatment ordered by an approved physician.
6. Tax deductibility for major illness insurance (catastrophic and hospitalization). No tax deductibility for comprehensive (such as outpatient) health insurance.

B. Nonprofits

1. Suspend and prohibit all further conversions of nonprofits to profits
2. Revoke the 1969 IRS ruling, and require nonprofits, to the extent of their financial ability, to provide services to those unable to pay.
3. Revisit the tax deductibility of donations to nonprofits.

C. The Pharmaceutical Industry

1. 1. Revoke the 1997 FDA ruling. Prohibit direct marketing of drugs and prescription medical devices to consumers.
2. 2. If government is to continue purchasing drugs (which we oppose), it should do so directly, without “middle men.”

IV. Medicare and Medicaid

A. Terminate Medicare Part C

B. Terminate Medicare Part D

C. Convert outpatient care from open-ended, third–party, fee-for service payment to health-care vouchers, illness based, given to patients.

D. Incarceration and fines for fraud.

V. Mandates

A. De jure (government)

1. With the exception of COBRA (if employer-based insurance is to continue), terminate all existing mandates.

B. De facto (NGO’s)

1. Preventive medicine measures to be carried out by non-physicians.
2. Terminate “pay for performance.”
3. Terminate all subsidies for computerized medical records, and all mandates establishing computerized medical records.
4. Limit recertification examinations to finite, manageable amount of new clinically relevant knowledge.

VI. Delivery of Health Care

A. Establish mandatory, high-deductible, major-illness insurance to cover hospitalization and catastrophic illness for those under 65.

1. 1. This insurance is to be provided by private insurance.
2. 2. If unreasonable premiums are charged by private insurers, then government-owned, contractor-operated insurance companies are to be established.

B. Outpatient health care to be provided on an out-of-pocket basis.

C. Shortfalls for out-of-pocket expenses to be provided by low-interest loans.

REALITY CHECK

Public policy is often set not for the public good, but for the benefit of parochial interests. Setting the American health-care system on a sound financial footing will meet with resistance from all of those special interests. Physicians will resist allocating some of their responsibilities to non-physicians, and nurses will object to the loss of documentation requirements that to some extent featherbed their jobs. Academia will insist a college education is necessary for the education of a physician. The courts will assert, and possibly rule, that tort law cannot be excluded from health care. The insurance and pharmaceutical industries will attempt to thwart any significant reform that cuts into their revenues. Similarly, the media will oppose any restriction on their advertising income from drug advertisements.

The financing of the health care industry, contrary to their protestations, works quite well for all the above interests. For the nation as a whole, though, it is a different matter.

However, supposing that the political opposition were circumvented and vast savings were accomplished in health care, it may still be that little is accomplished. Government may merely spend the money elsewhere. Even the Wall Street Journal notes that congressional pork, in the form of corporate welfare, amounted to $98 billion in 2007 and may exceed $100 billion in 2008.¹ This seemed like a large amount of money when the writing of this treatise began. Since then, a trillion dollars to Wall Street speculators “too big to fail” has become a new role for government.

CONCLUSION

The unaffordable cost of health care in America is an inevitable response to the omnipresent specter of litigation, the imposition of quality improvement initiatives, and the interposition of insurance companies.

The efforts to protect against the litigation threat and comply with the quality improvement mandates, through excessive testing and documentation, has corrupted the practice of medicine.

Similarly, there has been a corruption in the role insurance companies play in health care. They are suited only to provide insurance. They are not suited to manage health care. They do not provide that care, doctors and nurses do. The validity of managed care as a means of cost-cutting is nil. Other factors also play important roles, but unless litigation, managed care and mandates are removed from the equation, the problem cannot be solved.

Our plan turns conventional wisdom on its head. That conventional wisdom is a sinkhole. We propose, in effect, less “education,” less “law,” less “documentation,” less “insurance,” and less “quality improvement.” Sometimes, less is more.

We titled this book “Radical Prescription.” “Radical” comes from the Latin “radix,” meaning “root.” We’ve tried to develop a prescription that gets to the root, the underlying source, of the problem. Radical in common usage, however, means extreme. Unfortunately, this definition fits as well. Common-sense proposals appear extreme in today’s highly distorted legal and regulatory environment.

Contrary to the opining of experts, authorities and special interests, the solution isn’t that difficult. It requires only the political will.

If there’s a will, there’s a way.

Copyright © 2009 Radical Prescription.