A doctor’s view: Health-care reform’s key requirements

Recent years have shown that how we Americans organize and pay for health care is a major problem. The superrich and those covered with traditional Medicare and a quality supplement can sleep well at night.

Most of the rest must worry about availability and huge uncovered costs. Top-notch care is available in America “if you can get it.” Top-notch care is available in most other advanced countries as well, such as Singapore, Canada, France, Germany and some twenty other nations in the First World. In those nations, everyone can get good care.

Sadly, there remains considerable ignorance in our country about this dramatic difference. In the vanguard for reform is the Physicians for a National Health Program. This organization has one goal: to improve traditional Medicare and phase it in as the singlepayer program to cover all Americans. I am a member and believe this is the single most important reform that we need.

At the same time, there are literally hundreds of reforms, small and large, that are needed. Here are a few, in addition to instituting Medicare/single Payer, that are large and hence need early embrace:

• Change the malpractice system to a no-fault insurance system: Along with care, all patients would be covered with insurance that deals with economic loss due to a less-than-ideal result. This would be made largely in modest monthly payments for several months to many years, even for the rest of one’s life in a few cases. Actual malpractice would come into play in only the most egregious cases. Physicians would practice much less defensive medicine, saving lots of money.

• Ramp up public health to address obesity, hypertension, dietary concerns, drug abuse and the neglect and abuse of children: The old saying, “An ounce of prevention is worth a pound of cure,” is so relevant today. Overall, we Americans are just below average in our health status compared to other First World nations. Much more can be done to promote a healthy diet, exercise and the management of chronic illnesses such as hypertension and diabetes.

Child conservation above all needs a major new initiative. Too many kids are neglected, abused and unsupervised. They will underachieve, venture into crime and abuse drugs. We need to get outreach workers into their homes, neighborhoods, playgrounds and schools. Scouting, 4-H, the Y’s, the Boys and Girls Clubs of America and religious congregations need to be more engaged in the effort. These lost children need to feel they are valued. Also, they must be expected to grow to become responsible citizens.

• Make primary care far more available, especially in rural America: We need to double or triple the number of primary-care physicians. Currently they are underpaid, so wages need to rise. Clinic structures with primary care at the core need to be expanded, especially in rural America. Specialty care, often amazing, is nevertheless secondary and tertiary. In primary care, problems are caught early. Primary-care physicians are in the best position to refer to specialists and to manage follow-up. Primary care is good for our health and is good “bang for the buck.”

• Reduce the cost of attending medical and dental school: Today it is common for new physicians and dentists to owe $400,000 or more upon graduation. Student-loan interest rates are high. Specialty training extends the time until the new doctors can start to pay down their debts. At that point they may owe half a million or more. Patients are served best when their doctors can focus on healthcare needs, not feel pressed to make lots of money to pay debt.