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If I Designed U.S. Health Care . . .

Op-Med is a collection of original articles contributed by Doximity members.

There is a palpable demand among Americans for “Medicare For All” or a “Universal Health Care Plan for the U.S.A.” Immediately after graduating from the University of the Philippines College of Medicine in 1963, I immigrated to the United States to further my education and medical training. In 1972, I opened my private solo practice in Internal Medicine and closed it in 1992 when I was forced to join an HMO to survive the financial burdens a rapidly changing medical environment imposed. That environment successfully transformed the “art and science of medicine” to the “business of medicine,” wherein the bottom line is prioritized over patient care.

Through my experiences, I was exposed to, and studied, the many problems of the U.S. health care delivery system. In comparing it with the health care systems in other countries, I found 13 major problems, including rapidly increasing health care cost, affordability, and a large population (15 percent) without health care coverage.

Many corrective measures have been proposed to remedy U.S. health care without success — and so the rapidly increasing health care costs continue to accelerate with some estimates of $4–4.5 trillion per year in national expenditures by 2020. Because the U.S. economy is based on the principles of a “free market economy,” isn’t it reasonable to apply the important principle of “competitive bidding” health care? Doing so would allow the U.S. to actually determine the true value of health care services and products at all levels of the medical delivery system. It would allow the country to slow down, and even stop, the rapid increase of medical care.

I believe that U.S health care must be designed around five goals:

  1. Universal health coverage for all citizens and legal immigrants with permanent residency visas in the U.S., without exception
  2. Affordability
  3. Easy implementation
  4. Basic comprehensive medical coverage for all
  5. Allowing supplemental health insurance coverage for uncovered medical services

I truly believe these goals can be effectively accomplished by applying the following principles.

  1. Collect and pool all monies earmarked for health care as a health care superfund, i.e., Medicare, Medicaid, employers’ health care contributions to employees’ health care benefits, private/personal out-of-pocket expenses (including health insurance premiums paid by individuals or families, and so on);
  2. Redistribute the superfund to all the states and territories of the United States on a per capita basis;
  3. Allow the federal government to retain five percent of the superfund for administration, health education, and medical research and development—and allow each state/territory to take five percent of their state superfund allocation from the federal government for administration, health education, and medical research and development;
  4. Mandate that states and territories provide health care coverage for every citizen of the using a two-step bidding formula (i.e., secret and open public bidding) to ensure the best price is attained for that group of citizens;
  5. Allow the winning health care insurance company to provide health care coverage for all the citizens of the state or territory for a specified number of years … and then repeat the process;
  6. Issue a national health care ID to allow easy accessibility, portability, and efficient implementation of the health care program.

I sincerely believe applying the above six principles is the most effective and efficient way to provide and achieve health care for all Americans with a reasonable cost-benefit ratio. How would you design the U.S. health care system?

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