“America has the best health care in the world.” That’s a quote by tens of thousands of politicians, physicians, and people in the media. It’s been repeated so many times—actually, drummed into our heads since early childhood—that most people believe it. Is our health care system really the best? The answer is no, Americans are dependent on doctors who provide basic services, but doctors work fast and misdiagnoses are common. Health care is expensive with massive gaps in medical coverage. Roughly 20 percent of America’s population is uninsured, and that number is growing, while 26 percent need government assistance in the form of Medicare and Medicaid—46 percent of America’s population can’t afford health care without government help. Take away private health care insurance and only 1 percent of the population can afford effective medical care—about the same percentage of people in any Third World country.
Individuals have worked every day of their lives, done everything exactly right, paid tens of thousands of dollars in taxes, and still have to go to India or Thailand for basic medical care. In fact, other countries are providing quality health care to an increasing number of Americans at a far cheaper cost. Insurance companies are figuring out that we don’t have a monopoly on good health care, too. Why pay tens of thousands of dollars for a triple bypass when they can pay thousands of dollars in Thailand or India and receive the same basic service? In some cases, the “foreign” doctors are graduates of American medical schools and trained at America’s best hospitals. In many cases, the doctors and nurses are more professional, providing better personal care—they want Americans to come back. That can’t be said about American hospitals; they don’t care if a patient comes back or not.
No one is denied health care in America. An uninsured child with cancer is treated just as a child with insurance. The parents of the child are told to wait until all the bills are in before they declare bankruptcy. Doctors and hospital administrators know that the typical American family without insurance can’t pay the high cost of cancer treatment. The cost for the uninsured patient is added to government and private insurance costs.
Pick any street in working class America and one house with two working adults won’t have medical insurance. While the next house with nonworking adults will be insured by Medicaid. The more irresponsible an individual is the greater the health care benefits.
Even worse, Mexicans illegally cross the border and check into an American hospital because the health care is free. While an American, who’s paid more than fifty percent of his income in local, state, and federal taxes for the last thirty years, has to fly to Thailand for heart surgery. The poor simply refuse to pay for health care in America, while the lives of the working and middle class Americans are destroyed by the system.
American plastic surgeons have built clinics on islands in the Caribbean that are staffed by professionals from other nations, and where their income is tax-free. One island nation is planning a major resort-style hospital, staffed by doctors and nurses from Asia and South America, to provide health care to Americans at vastly reduced cost. It doesn’t take much effort to envision a health care insurance provider having a fleet of 747s flying patients across the Pacific or to the Caribbean to obtain cost-effective medical care. In the future, more of our health care will be outsourced, putting extreme economic pressure on the government-funded insurance programs, Medicare and Medicaid.
Hospitals in America are designed and built for the doctor’s convenience. In the morning, a doctor rushes to the hospital where he makes his rounds. He’ll visit a child with a broken leg, a senior citizen with pneumonia, a surgery patient, and a patient with a drug-resistant staph infection all in quick succession. Then rush back to his office where he sees his office patients.
Because doctors want hospitals close to their offices, (to save time and maximize their profits), there are too many small, inefficient, suburban hospitals with full lab departments, radiology departments, surgery departments, and emergency rooms—all underused. Maintaining staff and modernizing equipment becomes a delicate balancing act. The constant battle to keep income balanced with financial obligations and the medical needs of a community constantly push up health care costs. There is no end in sight to the number of small suburban hospitals, most of which are money pits.
Health care reform has been talked about; bills have been proposed, some have passed but most have been rejected. But most health care reform is just more of the same expensive insurance that we can’t afford. Medicare and Medicaid should be trashed as failed social experiments. They are a costly burden on the taxpayer, while damaging the overall health of the economy. With baby boomers set to retire, and the growth of cheap foreign labor, the system will be overwhelmed. Government-funded health insurance runs nearly 600 billion a year, and that number could reach a trillion dollars in the next twenty years. America no longer has the luxury of funding programs that don’t work.
In place of Medicare and Medicaid, the federal government would set up a VA style health care system. A government-owned General Hospital System would include trauma centers, clinics, and hospitals to serve the general population. At a VA hospital, a patient doesn’t see a doctor, they go to a clinic. A doctor or Physician’s Assistantdoes the initial screening, and the patient is referred to various clinics and services depending on the preliminary diagnosis. The system works a little slow, but it works, and the overall level of care at VA hospitals is excellent.
A triple tier system
Each individual would have a choice, pay for private medical insurance or pay nothing and use the government’s General Hospital System. A third option would be to use a Physician Assistant and private labs paying out of pocket—in conjunction with the General Hospital System, if major medical assistance was needed.In effect, the wealthy and portions of the middle class would purchase private health insurance, while the less wealthy would use the government-provided health care system. The middle class, senior citizens, and the poor would have a choice, pay for private health insurance, or use the General Hospital System. Each person would make the determination and choose what’s best for his or her family.
Centralized trauma centers would be the central hub in a government-provided health care. They would be approximately twelve miles apart, covering up to 150 square miles depending on population density. The Dallas/Fort Worth area with a population of six million would have approximately twenty government-owned trauma centers—fully equipped for all forms of emergency care.
Private hospitals would be barred from operating emergency rooms. In effect, this would reduce emergency rooms from approximately 110 in the DFW area to twenty—more than a three/fourths reduction. Speed is vitally important in emergency care. But it makes no sense to rush a sick or injured person to an emergency room, if the staff is not prepared to handle the emergency. Rushing to the hospital to sit and wait until an on-call surgeon and operating room staff can be assembled does no good—a ten-minute delay in the treatment can be costly, but a thirty-minute delay can be deadly. Centralized trauma centers would have dozens of trained medical personnel ready to care for an injured person. Because the medical staff would work for the system, teams would shuffle about depending on need.
Every hospital has an emergency room, hospital administrators don’t want to miss walk-in-patients, and ambulance runs—it’s all about money. The result is that too many hospitals operate small inefficient emergency rooms at an overwhelming financial cost. Keeping emergency rooms open twenty-four hours a day, seven days a week is difficult and expensive. The paradox of emergency room care: small suburban hospitals do not have a full complement of medical personnel on hand for each emergency, while emergency rooms, by definition, need to be fully equipped and fully staffed. Because they’re fully staffed and underutilized, emergency rooms are expensive and hospitals cut back on staff and equipment to save money. It’s a never-ending balancing act and getting it right is nearly impossible.
One emergency room will have staff sitting around, while the staff at another emergency room will be overworked, an hour later it’s reversed. The emergency room patient load varies and is difficult to predict. During school hours, for example, when kids are supervised, not many injuries occur. But after school between the hours of 3:30 and 5:30, kids are in more strenuous after-school activities, such as sports, and unsupervised activities such as skateboarding—that’s when more injuries occur. Emergency rooms will go from having nothing to do, to being overwhelmed, to having nothing to do in a very short period.
By junking the current medical emergency room system and having centralized, government-run, trauma centers and squeezing together staff and services, facilities would be better prepared to meet each emergency, at a cheaper cost.
Because a centralized trauma center would be busy, a form of triage would start before the patient enters the trauma unit. Major trauma victims (bloody wounds and broken bones) to one section, cardiology (chest pains) to a second and the sick to a third. Along with the trauma center, there would be an obstetrics clinic. All four units would be separated from the others with its own air ventilation systems.
In the news, a young woman giving birth at a hospital was infected with a flesh-eating bacterium—she lost her arms and a leg. Neither the doctor nor the hospital is to blame—the American health care system is to blame. At any emergency room in America there is a old man with chest pains, a kid with a bloody cut on his arm, a person with the flu, a pregnant woman, and a guy with a raw open infected wound, all patiently waiting their turn or lying in a bed with a curtain separating them. It’s not surprising that one of the most dangerous places for a sick person to be is a hospital.
In the Dallas area, seriously injured patients are rushed to Parkland Hospital the Dallas County Hospital, (where John F. Kennedy was treated.) Experienced trauma teams are on duty, and there is immediate access to surgery. Parkland serves about 150 thousand emergency room patients per year—about seventeen per hour. The top ten private emergency rooms in the DFW area each average eight patients per hour. The rate drops down, two or three per shift for smaller hospitals. It’s these smaller hospitals and their emergency rooms, over a hundred in the DFW area, which cost massive amounts of money to maintain.
Within five minutes of this writer’s home are three hospitals, all with emergency rooms. They are busy, but far from being overwhelmed, and the emergency room staff certainly has an abundance of slack time. Contrast that with ParklandHospital, a large urban trauma center in full swing. A gunshot victim is much better off at Parkland where the staff constantly handles gunshot victims, than at a private emergency room that handles one every other week.
The three hospitals in this area would close their emergency rooms, and a centralized government-run trauma center would be built and run exactly like ParklandHospital. From the trauma center, patients would be sorted and sent to appropriate clinics or hospitals. A hospital without an emergency room seems almost un-American, but centralized, fully staffed, trauma centers with full lab, radiology, and surgery capability makes financial and medical sense.
This is basic military triage. In Iraq, American causalities are shipped to centralized trauma units—the field hospital—and not to understaffed Battalion aid stations. A survey of doctors in America’s military service, and possibly Canada, England, or Germany would tell you centralized trauma centers will save lives. Survey American doctors and they would be appalled and tell you the system will never work.
Instead of Medicare and Medicaid, and side-by-side with trauma centers, would be medical clinics modeled after the VA hospital system. Physician’s Assistants and doctors working in the trauma center or the central admissions center would do the preliminary screening and diagnosis, sending the patient to the appropriate clinic or hospital, usually with a stop at radiology and the lab before they get to the clinic. This is what family doctors do. They do the initial screening, and then refer the patient to a cardiologist, urologist, surgeon, or psychiatrist.
Clinics would include cardiology, gastroenterology, orthopedics, cancer, psychiatry, and others, along with obstetrics and a well baby clinic. While the trauma centers would be free, the clinics would charge for their services. A visit would run from ten to fifty dollars depending on the income of the patient. The pharmacy would charge five dollars per prescription for the poor and cost plus 10 percent for a middle class family. An individual could cut his arm, go to the hospital, have a wound sutured, get a tetanus shot, and a prescription for antibiotics, all for twenty-five dollars, maybe a little more for a middle class individual—fifty dollars. These are token charges. People abuse free services and have little respect for the service or the service provider. While the government would provide the bulk of the service, all patients would pay a fair amount.
One problem in America, the poor simply refuse to pay even token amounts for health care, as if they’re entitled to free services because they are poor. Another problem, hospitals charge so much that even the middle class laugh at the bill because they can’t pay. Much of the cost is to pay for the massive amount of underused equipment, facilities, and staff
Clinics would charge for services, including the obstetric clinic, which would charge a hundred dollars for the birth of a first child, two hundred for the second, five hundred for a third, and a thousand dollars for the fourth. Every trauma center would have a dedicated obstetrics hospital, along with a well baby clinic.
A patient with a yearly income of thirty-five thousand that needs surgery and a week in the hospital would be billed on a sliding scale, maybe two thousand dollars. Today the same person, if uninsured, would be billed tens of thousands of dollars, have no ability to pay, and would file for bankruptcy—dehumanizing for the uninsured patient and nearly fatal for the health care system. In a government-operated and funded system, the patient would pay a fair bill based on income.
A five-to-six-hundred-bed general hospital would be built alongside each trauma center and clinics. The hospitals would treat all Americans, including the elderly, uninsured, the poor, and middle class regardless of income—fees would be based on a sliding scale. Specialized hospitals and in-patient clinics would be built and size would vary depending on need. Various types of hospitals would include:
3)Surgery and Orthopedic
6)Senior (Fifty Plus)
The Dallas/Fort Worth area might have two hospitals specializing in cardiac care, two dedicated to major surgery, one to infectious diseases, and three for psychiatry. Patients would be shipped about depending on their illness or injury. Surgery clinics would be built so that every room and every piece of equipment could be steam cleaned after use. Operating rooms would have the floor, walls, ceiling, tables, and equipment steam cleaned after each operation.
The spread of drug-resistant bacteria is one of America’s biggest medical problems. Modern hospitals try to do it all, and too many people die—one estimate is nearly a hundred thousand per year for all types of infections—because they catch a secondary disease or infection at a hospital. MSRA—twenty thousand deaths—is a deadly bacteria that got its start in hospitals. Common sense rules would be followed in developing a General Hospital System. Infected patients would be treated in a centralized facility where every room had a direct outlet to fresh air and medical equipment and hospital furniture could be sterilized with steam. It’s insane to treat individuals with the flu or an infectious disease in a hospital alongside surgery and cardiac patients. In one study, a VA hospital was able to reduce infections by isolating infected patients and using strict antiseptic procedure—basic 1950s common sense rules that aren’t being followed in big for profit hospitals.
From trauma centers and clinics, patients would be referred to the appropriate hospital. The current system is built not only for the convenience of doctors, but also for the convenience of the patients. They want a facility close to home so they don’t have to drive or wait, but convenient facilities are expensive to maintain and dangerous to the patient—an experienced medical team makes fewer mistakes. While medical equipment is expensive and should be used twenty-four/seven to justify the cost, but medical equipment sits idle much of the time. One estimate is that only sixty percent of total hospital capacity is being used at any given time. America’s health care system is a luxury, built for the convenience of the doctor and patient, not for the best medical care, but this is a luxury America can no longer afford. The General Hospital System would be built to provide the best medical care not medical luxury.
A good illustration: A hospital located in a mid-sized Texas city started a major cardiac surgery unit. It’s been closed, but while it was in operation, the survival rate was extremely low—the surgery team wasn’t adequately trained in cardiac surgery and post-surgery care. This is how unintelligent people are about health care and how much they believe that doctors always work in their best interest. The small cardiac surgery unit had plenty of patients. The average person wanted medical care at their doorstep, even if it kills them. The General Hospital System would have centralized surgery, cardiac, and specialized units. Best for the patient’s medical needs, but not best for the patient’s psychological needs or his family’s psychological needs.
With all of society’s rants about the government, there is a perfect rose. The VA hospital system is one of the largest paperless organization in America—medical records in the VA hospital system are digital. Any veteran, treated at any VA hospital, has his records at the fingertips of any VA doctor or clinic. MRIs, x-rays, and lab reports are on the computer system. Prescriptions, x-ray requests, and lab requests are digital. It’s the most comprehensive record-keeping system in the government, and it saves a huge amount of time, storage space, and energy.
The VA record-keeping system would be incorporated into the General Hospital System. The entire General Hospital System would be completely digital, but not on the internet. The system would be a government intranet system.
George Bush has pushed for a digital recordkeeping system for Medicare and Medicaid. But there has been a huge resistance from America’s medical community. Centralized recordkeeping would reduce fraud—it wouldn’t be surprising if 25 percent of the cost of Medicare and Medicaid were fraudulent. It would reduce prescription errors and illegal prescriptions.
A centralized record keeping system would make it easier for emergency room personnel to get an individual’s records, saving time and lives. Centralized recordkeeping should be forced on the medical community, including digital prescriptions.
Heavy penalties would be in place for the invasion and use of medical data from the General Hospital System, including mandatory prison terms and the loss of 100 percent of personal and corporate assets. Drug companies and corporation that used stolen data would be punished severely.
Nearly 90 percent of the responsibility that we’ve bestowed on doctors could be handled by someone with much less capability and education at a far cheaper price. The Physician’s Assistants program was developed to relieve doctors of the daily grind, but the program has increased health care costs because doctors have refused to give up any responsibility.
Physician’s Assistants should be allowed to open limited, cash-only, clinical practices under their own supervision, releasing them from the supervision of a doctor. Physician’s Assistants can write prescriptions for routine medicine, do minor surgery, such as cleaning boils and cysts and suturing minor wounds. It doesn’t take a brain surgeon to treat the flu, colds, and other minor illnesses. Well baby clinics would be staffed with Physician’s Assistants and/or Nurse Practitioners who would complete medical work-ups, give routine baby shots, and other care.
Because Medicare and Medicaid would no longer be available, costs for nursing home care would be assumed by the General Hospital System, just as long term costs are paid by the current programs. Nursing homes would have an in-house Physician’s Assistant and use the General Hospital System.
Physician’s Assistants would continue to work in small communities and send patients to the appropriate medical clinic or hospital in nearby cities. Minor surgery would be done in small cities, but major surgery would be done at major surgery centers. Small cities wouldn’t have to build complete hospitals systems; major problems would be transported out—inconvenient for the patient, but safer for the patient. A good doctor and well-trained staff are more important than a small hospital and underused staff that is close to home.
There is a shortage of doctors, in part because we train too many foreign doctors, who can make more money by heading back home after graduation—American trained doctors are in big demand. Then to compensate for the shortage, we bring foreign-trained doctors to America because they can’t make enough money in their country. American trained Physician’s Assistants and Nurse Practitioners are almost as knowledgeable as foreign-trained doctors, yet we pay a foreign doctor more, because they have an MD behind their name—only in America
Nearly all doctors in America are private practitioners. In the General Hospital System, approximately half of all doctors would be employees of the system. Doctors, Nurses, and Physician’s Assistants would be hired and fired exactly the same way any company hires and fires staff.
Because this system does away with Medicare and Medicaid, but doesn’t do away with private insurance, doctors would remain in private practice. These doctors could contract with the General Hospital System to provide medical services. For example, a heart surgeon might contract for two operations a week. As young doctors finish their internships, familiarizing themselves with the General Hospital System, many will stay with the system—replacing the headaches of establishing a private practice with a guaranteed income, vacation and a limit on the number of hours worked per week.
Parkland, VA, and Walter Reed
Parkland, the DallasCounty hospital, is one of the largest hospitals in the Dallas area, but its facilities are over fifty years old. It’s old, but it’s still the best trauma center in the Dallas area. Most of the complaints against Parkland have more to do with the facilities, not the quality of medical care.
It’s also true of the VA system. VA care is exceptional; Walter Reed, one of the best hospitals in America, has had negative news recently—but the VA system is being overwhelmed by veterans of the Iraq war, and some people are falling through the cracks. System facilities are old; some World War II facilities are still in use. The entire VA and military medical program has been underfunded—Medicare and Medicaid use vast amounts of money and there is very little money left over for other programs—politicians can’t cut Medicare and Medicaid, so they cut VA hospital funding.
But another problem exists, too. The VA disability insurance is almost 38 thousand dollars per year. It may take the average Iraq veteran ten years before he’s making that much—the competition to get on VA disability is high.
Post-traumatic stress disorder exists, it’s a real diagnosis—known as shellshock in WW I, and battle fatigue in WW II. But the number of Vietnam veterans diagnosed was higher than World War II veterans, and it appears as if the number of Iraq veterans diagnosed will be even higher. It pays for veterans with even minor symptoms to check in with the VA.
Are veterans exaggerating symptoms to get a VA disability check? Probably so. It’s normal for any veteran to have nightmares and sleep disturbance after a year or more in combat. It’s normal to have various physical ailments after combat. It’s also normal to exaggerate those ailments. It can take years to adjust to a less-intense civilian atmosphere—it takes time to get back to normal, and it’s a different normal than before combat. The war will never be over for WW II, Korean, and Vietnam veterans. They still tear up when they talk about fallen comrades—strong feelings remain close to the surface. For most, the war will always be there.
The soldiers and Marines coming back from Iraq and Afghanistan are seeking treatment. But the VA has a hard time telling who needs treatment and who doesn’t—who’s fighting for a disability check and who isn’t. It’s overwhelming for the veteran, who’s trying to sort out his or her feelings, and it’s overwhelming for VA’s staff when nearly every veteran shows up for medical treatment.
Attorneys are filing lawsuits against the government. Apparently, one lawsuit is demanding money for nearly every Iraqi veteran but the VA disability can ruin lives. The federal government needs to make sure that veteran get into school—college, or technical college and stay away from drugs and alcohol. No one on a VA disability should be allowed to abuse drugs or alcohol.
Nearly 600 billion federal tax dollars goes for health care in America—a massive amount of money. Allocating resources in America has become a dangerous balancing act—cracks appear, as some programs are underfunded—VA facilities and staff are worn out. But this doesn’t mean that the VA system should be abandoned. It does mean that limited tax resources need to be allocated better.
America’s General Hospital System would be protected from lawsuits. Doctors, Nurses, and Physician’s Assistants would have immunity from malpractice or negligence lawsuits. Complaints would be handled by a central arbitration system, and the results would be final. There would be fixed amounts of money paid, but only if the trauma center, clinic, or hospital was at fault and only if real damage occurred. The total amount of monetary awards would be capped—the multimillion-dollar judgments would end. People without any real injures have sued and received money even when they haven’t been harmed. The fear of being injured or harmed should not be litigated in a courtroom.
The standard of care at VA hospitals is excellent. At the same time, veterans are barred from suing the hospital or doctors. The lack of litigation may actually work in the veteran’s favor. Because the staff isn’t burdened by the fear of lawsuits, they can act in the best medical interest of the patient, not in their best legal interest. By providing legal immunity and reducing personal liability, the cost of health care will drop—unneeded tests won’t be offered. However, General Hospital System’s staff would not be protected from the criminal justice system. This is not carte blanche to act in a completely negligent manner.
The new prescription drug bill passed by Congress and signed by President Bush is the most bizarre bill ever passed by any government. It’s too big, too complicated, and too anti-taxpayer. Figuring out which section benefits an individual the most is extremely difficult, but it’s not difficult to figure out which sections benefits drug companies—sections A through Z. The cost at one time was estimated to be thirty billion, then sixty billion, and now some estimates are near a hundred billion.
It may become the most abused welfare program in the history of the United States. Abuse in unemployment insurance, workers comp, and the Food Stamp program is rampant. But the possibilities of abuse in the new prescription drug law are incredible. While the poorest of the poor will receive the most benefits, most need money, not some high-priced cholesterol drug, or other fancy drug guaranteed to extend life. A seventy-year-old man living on Supplemental Social Security of six hundred dollars a month will have access to high price life-extending medicine—as much as a thousand dollars or more a month. Pharmacists and/or drug companies operating on the fringe of society will fill the prescriptions and offer the man a few hundred dollars cash for his monthly allotment. They will bill Medicare for the drugs and re-sell them. The seventy-year-old man will have extra spending money, the pharmacist will double his income and the taxpayers will be screwed.
The most damaging part of the bill forbids Medicare to use its immense buying power to negotiate prices with drug companies. That’s like Wal-Mart accepting whatever high price the manufacturer sets. The bill takes advantage of the American taxpayer, and it should be rescinded immediately. In the General Hospital System, it would be mandated that government-run facilities act with a Wal-Mart-like ruthlessness and negotiate directly with drug companies to purchase drugs at the lowest possible price.
Individuals would pay for their drugs. The poor would pay a modest amount, while others would pay cost plus a set fee. The General Hospital System would negotiate a set cost for each drug and private pharmacies would fill the prescription for a fee. For example: if the cost for Lipitor was twenty-five dollars for a month’s prescription, a pharmacy would charge thirty dollars, twenty-five for the drug and five dollars to fill the prescription. Inefficient pharmacies or pharmacies that don’t want to participate wouldn’t have to.
Drug companies claim that they need a large return on new drugs because of the high price of research and testing that goes into each new drug. Jerry Lewis has raised hundreds of millions of dollars for muscular dystrophy research; if there is a cure or treatment, most people won’t be able to afford it, and the government will have to subsidize the cost. Millions of people donate hundreds of millions of dollars to research various diseases and illnesses—nearly every disease has a foundation, from the very successful March of Dimes to the National Parkinson Foundation. The federal government spends billions on cancer, heart disease, HIV, and other illnesses.
Drug companies use money from their high-priced drugs to fund research into high-priced drugs. Many illnesses aren’t being researched because the drug companies can’t make enough money. The flu is a good example. Big drug companies won’t do flu research because there is limited money in the process. It took a big drug company six months to produce a new avian flu vaccine that’s easier to make and more potent than the current vaccine, but only after President Bush allocated some six billion dollars to avian flu preparedness. The big drug company didn’t pay for the research, the American people did. It’s the same for antibiotics. There is limited research, because antibiotics aren’t the billion-dollar drug that people buy month-after-month. The balance of medical research has tilted in favor of the billion-dollar drug market that extends life. These are the drugs that healthy people take.
Research into cures for a multitude of human ailments is limited by the number of people afflicted. Billions of dollars are being spent researching Lipitor-two, and millions of dollars are spent researching flesh-eating bacteria—there is no longer any balance in medical research. Because the federal government would negotiate the lowest price possible, the price for drugs would drop. Because billions of dollars will be saved, more research will be funded by the government and a better balance will be achieved.
We’re already paying
America already pays more for health care than any other country. The General Hospital System would be paid for by the state and federal government with money already allocated for Medicare and Medicaid—that currently runs about 600 billion dollars. American businesses would pay two hundred dollars a month—twenty-four hundred dollars a year—for each employee, regardless of their status—part-time, contract, union, non-union, and management—roughly 360 billion dollars. Social Security recipients would pay fifty dollars a month for a single or a hundred dollars for married couples, roughly 40 billion. People using their guaranteed loan would also have money deducted for health care. A trillion dollars would be available for the General Hospital System.
It would not be a free system. There would be fees based on a person’s income, with a minimum of ten dollars per visit and ten dollars per prescription, a thousand dollars for a minor operation, two thousand dollars for a major operation, the equivalent of the deductible that’s paid now. An unmarried individual on kidney dialysis, a Parkinson patient, or other long-term disability would pay his or her 600 dollars plus a 1200 dollar a year deductible.
Businesses would pay the twenty-four hundred dollars per employee. In return, they would be barred from paying for private health insurance. Unions would be barred from negotiating health care benefits, and companies would be barred from paying the health care costs of retired employees. In effect, each person would have a choice; pay nothing and use the General Hospital System or pay for private insurance. Seniors would buy their own insurance if they could or use the General Hospital System—a choice that will lower American health care costs.
People abuse the current company-paid or government-paid system. When companies pay for private medical insurance, people want first class health care and some people try to max out on benefits by getting unneeded treatment. A doctor will cater to his or her financial needs first, then the patient’s psychological needs, and then the patient’s medical needs. Expensive treatment for minor health problems has overburdened the entire system.
A guess is that sixty percent of the population would use the government-provided health care and forty percent private insurance. Obviously, wealthy individuals would not use government-run clinics or hospitals, but in case of a heart attack, a car wreck, or serious injury, he or she would use the centralized trauma center, where a patient would be stabilized and sent to the appropriate private hospital. Trauma centers would be used by everybody at no cost to anyone. For normal, non-emergency hospital care, they would check into the hospital, just as they do now. A well-to-do senior citizen might want full medical coverage from a private insurance company at his expense. The individual would use the trauma center, if needed, and from there he would be transported to his or her preferred hospital. Private hospitals would not admit patients without medical insurance unless they prepaid for services. They would also be protected from lawsuits when they turn individuals away.
Private medical insurance programs would be separated into physician care (part one) and hospital care (part two). A senior citizen might purchase a policy covering physician care, but not hospital care. A physician would treat the patient at a GeneralHospital facility, where he or she would have the same privileges that he has at a private hospital. The doctor would bill the patient and medical insurance provider just as he does now. An individual could also use a cash only doctor or a Physician’s Assistant for minor medical problems and the General Hospital System for major problems. The General Hospital System would be flexible, much more flexible than the current system, giving the patient more choices.
There would be no co-pay, private insurance extras, or forms to fill out. There would be no gigantic hospital bill to look through or shred up. There would be no decisions about which plan would benefit a person the most.
American doctors have the absolute authority to make diagnoses. They control the patient’s access to lab tests, ultrasounds, x-rays, and nearly all diagnostic equipment. Partial responsibility needs to be returned to the individual by offering various diagnostic tools to the public.
Ovarian cancer often goes undetected. A woman goes to the doctor complaining of abdominal pain. The doctor assumes that it’s just normal everyday aches and pains of an aging human—doctors, trying to make big bucks, don’t spend a lot of time with individual patients. If the patient trusts the doctor, and doesn’t complain, ovarian cancer may go undetected.
The first step in detecting ovarian cancer is an ultrasound exam, the second step is a lab test, and the last step is a biopsy. Women should have access to the first and second step—a home ultrasound machine and access to medical labs.
A home ultrasound machines would consist of the transducer, the wand that’s rubbed across the belly or chest, a home computer, and a computer program. It should cost about the same as sonar for a bass boat—three to four hundred dollars. It would be used to take yearly picture of various internal organs—liver, spleen, kidney, ovaries, and heart, including veins and arteries.
In the doctor’s office, a technician rubs the transducer over the adnominal cavity, legs or neck, when a good picture of the kidney, liver, or leg veins is on the screen, the technician clicks off a digital picture—most people can learn to do this. The average person can learn to interpret a sonogram. Bass fishermen have sophisticated sonar gear, some more sophisticated than the ultrasound machines found in doctor’s offices. Fishermen spend enormous amount of time learning how to read the information obtained from sonar location. If the average person spent half the time bass fishermen spend, they would do just fine. In Hollywood, a well-known individual overused the sonogram machine to view a fetus—using an ultrasound machine as a toy, instead of a medical instrument. Classes could be required before purchasing an ultrasound machine. Community colleges would develop self-help classes, teaching the fundamentals of ultrasound.
The ultrasound machine is an under-utilized medical instrument. Women need yearly pictures of their ovaries from age thirty-five. Men could watch their veins and arteries clog up—hopefully, a picture of a clogged blood vessel would change more diets then a thousand warnings.
Doctors’ charge up to five hundred dollars for a sonogram, and insurance companies won’t pay for routine sonograms. In fact, it would be a huge waste of the health care dollar. Because the ultrasound machine is a noninvasive tool, its real place is in the home, not the doctor’s office. As a first step in the diagnostic process, it’s an invaluable tool.
EKG or electrocardiograph technology is another physician-controlled technology that should come in a home version. We’ve all heard people say, “I’ve got to go in for an EKG test” as if EKG is some sophisticated exam that takes years in medical school to learn how to administer and interpret. But just about any person can learn how to administer an EKG exam in an hour or less. Reading the results may only take a few hours of study. But this technology is so controlled that even the thought of an EKG test can produce anxiety.
A home version would use the personal computer, a software program and eight or nine leads that are connected to the chest—the cost should be a few hundred dollars. Community colleges would have classes on the process and reading the EKG. People need to have a yearly EKG for comparison purposes, but we don’t do this because of the cost. Insurance companies won’t fund it because doctors charge too much, and doctors won’t do it because insurance companies won’t pay.
Miniature cameras are swallowed to look for signs of tumors and polyps, and it should have a home version. It costs a thousand dollars at the doctor’s office, and most insurance companies will pay, but it’s used when a problem grows large enough to produce symptoms. Today’s medical market for miniature cameras is small, but if only a third of the seventy million baby boomers bought a home version of the camera at $350 per unit, it would be a ten billion dollar market. A reusable miniature camera, used once a year could potentially spot problems before they become serious.
These items are non-invasive first-step diagnostic tools that should be available to the public—it’s preventive, proactive medicine. Individuals should be charged with a limited responsibility to monitor their heart, organs, and overall health. Doctors have kept control of these products because they want to ensure that prices remain high. Ironically, doctors have such a tight control that most American can’t afford health care.
Most people are familiar with the plastic stick pregnancy test. Pee on the stick, wait ten minutes, and compare the results to the color chart. Dozens of plastic stick tests are available for use, but most are available only in the doctor’s office. For example, plastic stick tests for blood in urine or stool. Another plastic stick test is the HIV test. The company making the product claims it’s 99 percent accurate. Congress has debated—twice—whether this test should be available to the general public, so far the answer has been no. The reason is that doctors and HIV counselors want to keep control of the diagnostic process and the office visit fee—it’s all about control and money. The company that makes the test, charges doctors twenty-five dollars per test; the doctors charge forty dollars or more for the test plus the office visit. Paying a hundred and forty dollars for a test that can be done at home is insane and it’s why we have such high medical costs. All plastic stick tests should be available to the public, and companies should be encouraged to make more.
Not only do doctors control non-invasive diagnostic tools, they also control access to medical laboratories. Routine blood tests cost an arm and a leg. Doctors charge hundred dollars for an office visit, order routine tests, and overcharge for the tests. Medical Labs should set up retail outlets, and individuals should be allowed to order lab tests at their cost.
If private labs open their doors to the public, an LVN or certified lab tech would take blood or swab a cheek, and the lab would run routine blood analysis or screen for diseases like a prostate-specific antigen (PSA), or ovarian cancer. An employer might routinely order a standard set of tests for his employees and skip the cost of the yearly physical.
Lipitor, for example, needs constant liver screening. An individual should be able to skip the doctor, go to Wal-Mart, have a liver enzyme test done at a lab owned by Wal-Mart, or contracted by Wal-Mart and have them fill a Lipitor prescription. The liver enzyme tests might run twenty dollars, saving the hundred-dollar office visit and several hours of time. Wal-Mart, CVS Pharmacy or any grocery store’s pharmacy should have a lab or contract for a lab, increasing the competition and lowering health care costs. In today’s health care system, there is no competition between medical labs.
A couple for example, would take yearly digital pictures of their internal organs with a home ultrasound machine. They wouldn’t necessarily look for cancer, which is difficult to diagnose, but look for changes from year to year. In the event of a change in the woman’s ovaries, she would go to the medical lab at Wal-Mart and have an ovarian cancer-screening test performed. If the results were abnormal, the lab would direct the woman to her doctor. The doctor would redo the ultrasound and reorder the lab test. If the doctor confirmed the woman’s findings, the doctor would perform a biopsy. This is proactive medicine involving both patient and doctor.
It would also reduce anxiety. A woman who saw the change in her ovaries and who saw the results of a lab test would be more likely to have a biopsy done quickly. There would be no second opinion—in fact, the doctor would be the second opinion.
Having control of one’s destiny gives people power, reducing anxiety. The bottom line—instead of going to the doctor’s office complaining of a pain in the abdomen, a person should go to the doctor’s office with digital pictures, lab results and a basic idea of what’s wrong.
Of course, doctors will provide hundreds of reasons why this can’t possibly work. Self-treatment and self-diagnoses are dirty words in a doctor’s office. American society has given doctors the responsibility and the burden to make medical diagnoses—but misdiagnoses are common—one guess is that 15 percent of all patients have been misdiagnosed. Read any self-help group’s blog and people go through hell to get a correct diagnosis. Control of a patient’s access to diagnostic equipment has become a huge burden on the medical community.
Misdiagnosis and Designer Diseases
Look up autism in any five-year-old developmental psychology textbook and you will see the prevalence of autism is 1 in 10,000. Recently a non-profit group noted that 1 in 166 kids had some form of autism—kind of makes you wonder who’s funding the “so called,” non-profit groups. Interesting enough, the old autism had no cure, but the new autism has a cure. The old autism was easy to diagnose; autistic kids are severely detached from their environment—parents were not surprised by the diagnosis. The new autism needs doctors, teachers, and psychologists to make the diagnosis and it can surprise the parents.
Adult attention-deficit disorder is so broadly defined; nearly every other adult could be diagnosed. Most boys have some degree of attention-deficit disorder. Add in massive amounts of sugar and a multicultural school system and boys stay hyperactive.
All of these disorders have one thing in common: they are medical diagnoses. Once the diagnosis is made, a massive amount of medical care is available—medical insurance and/or government programs are available to cover the cost. Some patients with these diagnoses become eligible for disability insurance or fight for disability insurance.
Multiple personality was a common diagnosis in the eighties and early nineties, but then it was upgraded to Dissociative Identity Disorder with realistic criteria. But for a time it was the rage and every other patient seemed to be diagnosed with a multiple personality, but in all likelihood it is a very rare disorder. Bipolar is the current hip diagnosis, but all human beings are bipolar to one degree or another, determining when a patient needs drug treatment and psychotherapy becomes difficult, and in many cases, the better the medical insurance, the more likely the treatment.
In 1990, a book, Smart Drugs and Nutrients was written by Ward Dean, M.D. and John Morgenthaler. The book outlined various drugs and compounds that increased concentration and cognitive thinking. The book seemed to motivate drug companies to take a second look at drugs in their portfolio, opening the door to the secondary nature and use of various drugs.
Designer diseases started popping up with available treatments—designer diseases always come with available treatment. This is what has happened. A drug has particular properties, a medical condition can be defined and described that would benefit from the drug’s secondary properties. Dilantin, for example, is a treatment for seizures, but it also increases concentration. A designer disease can be defined for those with a wandering mind. A small daily dose of Dilantin can help an individual concentrate. New medical conditions are popping up all the time or being redefined like autism—once a person is diagnosed with autism or other designer disease, massive amounts of money is available.
A hyperactive boy or adult diagnosed with attention-deficit disorder would benefit more from deleting all the sugar in their diet—including soda pop, candy cereal, and fast foods that have added sugar. But no one makes money from a change in diet. Doctors make money by prescribing and monitoring drugs.
Would the General Hospital System reduce the number of diagnoses? Most likely. Doctors wouldn’t be motivated by money. Would people be unhappy? Most likely. People want the promise that our current medical system seems to offer, quick fixes for what ails them or what they think ails them. People don’t want to hear about a change in diet or lifestyle. They want a quick fix with a fancy drug—regardless of the long-term consequences.
The media hammered at the bird-flu virus—it was all we heard for months—like an old-time town crier predicting doom. The federal government did what they usually do—they threw money at it, to the tune of six billion dollars. But not one single American is safer. The flu vaccine is still being made overseas, partly in England, partly in Asia. In a flu pandemic, America might be second or third in line to get the needed vaccine. We would be in the same boat as any African, Latin American, or Asian country that produces little or no medication for its people. In a pandemic, America would be a Third World country waiting for the developed world to produce a vaccine.
The government’s solution was to pre-stock drugs, but it makes no sense to pre-stock drugs that may or may not be used, and could be a huge waste of taxpayers’ money. Today’s drug of choice may be the worst drug for a pandemic. Next month or next year a new drug will be developed which could be twenty times more effective. A billion dollar drug purchase today could be in a landfill tomorrow.
Apparently, American drug companies can’t make enough profit producing a flu vaccine. When American businesses, in their great wisdom, decide they can no longer provide certain basic commodities or services—the government needs to step in. Three hundred million Americans shouldn’t have to depend on the English, Chinese, or anyone else to produce our flu vaccine or any needed service or product.
The federal government should charter a company to build research and production facilities to produce the flu vaccine. At the same time, the chartered company could produce and sell the vaccine to other countries. The beauty of a chartered company is that it can be run as a for-profit business. Its mandate would be to produce the flu vaccine and sell it in a profitable manner, not necessarily, a Wall Street mandated profit, but a reasonable profit.
The company’s initial responsibility would be research and production. In time, other vaccines could be produced, including the polio vaccine and childhood immunizations. Research and development of antibiotics would be added. Nearly all of America’s antibiotics are produced overseas. In time of war or severe upheaval, America needs to be able to produce basic medications on America soil. By outsourcing the production of goods, American businesses have left the United States extremely vulnerable to political upheaval. It’s not only oil; we’ve become dependent on other countries supplying our most basic needs.
In a pandemic, America will have no friends—not one. We can’t depend on foreign companies or foreign workers. We can’t depend on England, China, or any other country to produce a vaccine. In a pandemic, a country’s absolute moral obligation and responsibility is to take care of its own population first and other countries second. Try to imagine Britain shipping millions of doses of a vaccine to America while their population goes unvaccinated. They won’t do that. In fact, if England were able to supply their entire population, any overproduction would be shipped in equal amounts to European countries, Canada, US, and Australia.
At the same time, the federal government, the military, the media and drug company experts have all stated that we do not have the capacity to produce a vaccine quickly. We need to build that capacity. The goal would be to pre-stock manufacturing capacity. With a population of three hundred million, the chartered company may need twenty production facilities located near our largest cities ready for full production. Instead of stockpiling one drug or several drugs, we would stockpile the capability to produce and distribute a large number of doses of a single drug quickly.
Prepaid flu vaccine
About thirty thousand deaths can be attributed to the flu each year. Most are the elderly, very young children or individuals with compromised immune systems. Healthy individuals can fight off the flu quickly without any long-term consequences—most healthy adults don’t need a flu shot. Yet we’ve had a flu vaccine shortage two of the last three years.
Apparently, this is what happens: the media announces that the flu season will be bad. People who normally don’t need or get a flu shot, rush to the doctor’s office. The media announce that there is a flu vaccine shortage. There is a huge rush to get flu shots, and a shortage occurs.
Public health organizations and foreign vaccine manufacturers have to guess how many people will need flu shots, a full year before anyone gets a vaccination. If the guess is wrong, there is too much or too little.
A typical, big-city, health department might order vaccine for fifty thousand people at the taxpayer’s expense, but sixty thousands people show up for a shot. They have a shortage. The next year, they order sixty thousand flu shots, but only forty thousand people show up. The health department dumps twenty thousand bottles of flu vaccine in the trash. The following year they order forty thousand and sixty thousand show up for a flu shot. No one is planning anything. It’s a simple guessing game, and that is sad.
Instead of guessing at the amount of vaccine needed, we need a federal law that anyone, including senior citizens and the poor, who wants a flu vaccination would have to prepay for the shot. Between August and November, a patient would go to the doctor’s office or health department to prepay for a flu shot and then return the following year for the shot. By the middle of December, doctors and health departments would know how much vaccine was needed for the following flu season and place their prepaid order. The poor would prepay a token amount at the city health department.
Instead of the yearly rollercoaster ride—the health department would know the exact number of flu shots needed. There would be nobody standing in line demanding a shot and overwhelming the system. The federal government should mandate prepaid flu shots, and if an individual doesn’t prepay for his vaccine, he or she is out of luck. What’s wrong with that? It would be a good dose of reality—Americans taking responsibility for themselves, that’s almost new.
Planning and coordinating research
The chartered company’s mandate would include planning and coordination of research with American universities. Determining America’s vulnerability to supply disruption including antibiotics should be a high priority. America is in the odd position, that some of our most basic and vital drugs are produced with our technology in other countries. It may not seem scary to have drugs and medical supplies made in Europe or Asia, but cut off the flow of goods, and an instant shortage will develop. Besides basic drugs, the chartered company may need to build the capacity to produce syringes, needles, and other medical supplies.
Developing a trained and skilled labor force
Most Third World countries have 100 percent of their drugs provided by other countries; they have no manufacturing ability or skilled labor force. If 50 percent of a country’s drugs are produced in other countries, the skilled labor force is reduced by 50 percent. It’s the same for America. As others produce our drugs, the pool of skilled labor is reduced. The chartered company would develop training programs for medical students so manufacturing and production expertise would be developed. Training might last from a week to a month, and students would learn the basic skills necessary to produce a vaccine. In a pandemic, a large, skilled, labor force would be needed quickly. Pre-training may be a necessary objective to achieve the desired size labor force.
The process to make flu vaccine is well know, but it may take three months to isolate a new strain of flu and three more months before a new flu vaccine is ready. The charter would include pre-stocking equipment and supplies. If a bird-flu pandemic starts in China, the federal government would have to stop the flow of goods coming to America. Basic medical supplies, gloves, needles, and syringes would be in short supply.
In a pandemic, people go a little crazy and mobs may become violent. The facility would need the ability to feed and house its work force for as long as six months. An armed force may be needed to protect the production crew, besides stockpiling medical supplies, it may be necessary to pre-position weapons and ammunition.
All right, we’ve done everything right. Production of a pandemic flu vaccine is coming online. Who gets it? In a pandemic, it’s easy to determine who gets a flu shot. It’s basic medical triage. The federal government has an absolute moral responsibility to do the best they can for America. As limited amounts of vaccine come on the market, medical personnel would get the first vaccinations, followed by the police and their families. Then young adults, beginning with college-educated under the age of thirty-five, college students, juniors, and seniors in high school. In a pandemic, the federal government has to save American’s educated, breeding stock first. The second group is the thirty-five to fifty-five-year-old working professionals and their families. After that, it doesn’t really matter maybe on a lottery basis. It’s even easier to determine who won’t get a pandemic flu shot: criminals in jail, drug addicts, people over the age of sixty, children under the age of seven, and high school dropouts.
While some Americans may find this offensive, it’s basic medical triage. This writer was offended and embarrassed by the federal officials who announced that senior citizens would be the first to get pandemic flu shots. That’s smart, let our children die, and save a bunch of retired people. What were these people thinking about? Federal officials are either stupid or too politically correct. In a pandemic, when hundreds of millions of people are dying, countries that make the hard decisions will survive, and the countries that make the politically correct decisions will not—it’s that simple.
Health care change
The marketplace has failed. The American health care system is a hybrid, half socialism, and half capitalism. The socialists, in this case the government and private, insurances companies pay the bill and the capitalists, the doctors and hospitals make the money. In the current system, we pay a medical insurance premium—a tax—to insurance companies who act as a third party on a patient’s behalf—this is even worse than socialized medicine. Insurance companies’ wants to make a big profit along with doctors and hospital—the American population has a hard time paying for all that profit. Large group plans have not led to lower medical costs in fact large group plans are the reason medical costs keep raising.
The current system doesn’t provide anyone with a choice. A person qualifies for Medicare, Medicaid, or his company has a group plan—or he doesn’t have insurance. The proposed General Hospital system provides for a choice, pay your own way, or have the government provide health care.
. Home diagnostic equipment would be available along with testing equipment and private labs forcing people to be more responsible for their health. Physician’s Assistants would be empowered and allowed to set up their own private practice without doctor supervision. The government-funded General Hospital System, trauma centers, clinics, and hospitals would replace Medicare and Medicaid. This is health care change, not reform.
Doctors at government-funded facilities won’t be pressed to see a high number of patients—spending more time and energy with each patient. Private practice doctors have a tendency to overbook, make quick medical decisions, and order tests and procedures that are unnecessary. The pressure for a private practice physician to produce a revenue stream covering his office overhead and lavish lifestyle is great. Doctors in government-run facilities won’t have the same financial pressures or the lavish lifestyle. The only pressure will be providing quality service.
A General Hospital System will save American jobs because businesses won’t be burdened with the high cost of health care. Because all companies would have to pay for General Hospital system, the cost will be spread out. Wal-Mart, for example, who pays nothing today, would have to chip in 2.4 billion dollars per year for their one million employees, an affordable amount.
Medicare and Medicaid costs Americans six hundred billion dollars per year in a wasteful system that barely meet the needs of the elderly and poor and certainly doesn’t meet the needs of the taxpayer. With baby boomers starting to retire and with the growth of illegal cheap labor, fixing the health care system is a high priority.
Talk about health care reform is heard on a regular basis, but it’s not reform, it’s the same old stuff. The government keeps trying to fix it with add-ons that don’t work. The government should provide universal health care for the poor, the middle class, and the elderly, everybody else should pay their own way.
 No one should wonder why hospitals are the primary source of drug resistant infections.
 No doubt, doctors will be predicting doom and gloom, but it would be their doom and gloom, not the governments, and certainly not the taxpayers.
 Parkland stays so busy that they’ve contracted with a private hospital for emergency room care.
 This writer has no actual insight into the cost of electronic gadgets. But electrical leads are cheap, personal computers are underused, a small box that transfers electronic pulses from a lead to a computer can’t be that expensive. A computer program that would read and store the EKG results should be inexpensive.
America is supposed to be a leader, but year after year, we listen to the media harp about a vaccine shortage. It’s more than sad, it’s embarrassing.
 In America, we don’t talk about kids between the ages of sixteen to thirty as breeding stock, but that is exactly what they are, and we have to save the kids who have been responsible enough to stay in school and get a college degree. We do not save high school dropouts or criminals. This is not racism, far from it, no government would let their responsible citizens die while saving the irresponsible.
 Children under the age of seven can’t live on their own. Save the parents because the kids can be replaced. In a pandemic with millions of deaths, hard decisions need to be made. Moral governments make the hard decisions.