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Real Health Care Reform for Americans

May 1, 2017

Now that the topic of health care “reform” has resurfaced onto the national policy agenda, here is a five-point plan that can bring real reform to bring health care to all Americans. To move in this radical, but effective, direction, the loyal ACA supporters need to accept the reality that Obamacare is not sustainable; it is imploding. And those keen on repeal and replace must be open that this plan is not socialized medicine but consistent with Americans’ historical values to “promote the general Welfare.”
  • Dump insurance companies:  Health care and health insurance are two different activities that assist in making us healthy. We need attention to our health care providers and system, not fussing with health insurance rules and regulations. Obamacare was souped-up policy incrementalism that focused on health insurance but did little to improve cost and care. Health insurers, in the end, are fat in the system whose aim is to artfully move us between and among risk pools. ACA put a leash on the tiger, but we are still left with the tiger.
  • Get employers out of health care: Companies and all organizations should invest their people and their time in doing whatever it is the companies purport to do, e.g. make better widgets or provide better service. Having employees and consultants involved in our health care is more fat and waste in the system. Have these people go back to work.  Furthermore, when our property (labor) is linked, even tacitly, to our person (health care of), we abdicate control to our employer, and thus we misuse an inalienable right. Such an exchange of our person is philosophically and morally untenable. We must relieve employers of any control over our health care. 
  • Draw money to a single government entity: Moving money between and among entities is more fat and waste in the system. Each citizen can pay to our government something and the government, in turn, pays the providers. Collect the money from the citizenry through our income tax system, according to each of our abilities to pay. The amount, we should be hopeful, is something our social economists can determine.  
  • Establish evidence-based panels that define standards of basic and humane care: The problem in the current system is we have multiple expert panels with conflicting opinions on care. We have the talent and people with reason and compassion to establish official guidelines for basic care. This advice is analogous to us turning to the U.S. Preventive Services Task Force for advice on what to do in health care.  
  • Keep our mix of health care providers: Our health care providers and the many support services and products that go into a market-driven health care system is something we can be proud of. Providers are driven by our willingness as a people to use our talents, experiment, invent, and innovate and work hard to improve the human condition. We should do all that we can to develop a health care system that supports the people who wish to work in these most important professions and businesses-- be they private, nonprofit or government established.  Government providers need only expand and contract delivery of service when there is a gap that the private and nonprofit providers are not filling. The challenge is to create a system where those who excel and are committed to the healing arts can reach everyone and be properly rewarded. 
If we are “one nation under God,” so to speak, and agree to respect each other’s inalienable rights, doesn’t it make sense that we all join in the same health risk pool and work from there. This five point plan repeals the fat and waste that has built up and supports what is fundamental to caring for our people. 
Stephen F. Gambescia is professor of health services administration at Drexel University.