A HEALTH CARE PROPOSAL

WITH EMPHASIS ON

VARIABLES RATHER THAN IDEOLOGY

By Robert DePaolo

It has become evident that neither the curent Democratic nor Republican health care proposals will prove sufficient. That might be due to the ideological baggage encumbering proposals from both parties. Both have the best of intentions. The Democrats believe in support - but also entitlement. The Republicans believe in merit but have perhaps carried the concept of self sufficiency beyond the parameters of the normal curve. The Democrats believe in short term solutions that could have negative, long term ramifications while the Republicans are more concerned with long term, big picture implications, arguably to the exclusion of immediate impact.

Despite the newness associated with the Republican and Democratic proposals, the arguments on both sides are virtually the same as they have been for decades. Since the problem of providing universal health care hasn’t been solved during that time, it seems rather pointless to even have the debate, or to consider yet another global approach to the problem such as presented by the current president.

I would argue that in order to properly address the problem requires discussion of the variables involved in rising health care costs, resolve as many of those variables as possible and acknowledge that there are some we can’t solve The variables are as follows:

1. People are living longer, and older citizens tend to accrue more medical costs - which is non-remediable

2. There aren’t enough young (low risk) people - even if mandated to buy insurance - to make up the difference - also non-remediable

3. Medical technology has become very sophisticated, thus improving diagnostic methods. But that technology is very expensive and it has increased the cost of diagnosis and treatment, especially since these instruments cannot be mass-marketed - this is remediable

4. A financial battle has ensued between providers and insurance companies. Doctors are pressured to test for everything, regardless of probabilities of illness onset, to prevent the need for more drastic and costly treatment. In response to that, they have seized the opportunity by over-testing, lowering standards of normalcy for blood pressure, glucose levels and other systemic measures and by using an unorthodox, deterministic model of health and disease that runs contrary to how the body functions - also remediable

5. Insurance is too burdensome on businesses, so they are requesting larger co-contributions from workers, or in some cases discontinuing health insurance coverage altogether - which is non-remediable.

6. Insurance companies, are typically quasi-monopolies, with many companies being excluded from certain states - thus narrowing the competitive field. The best they will do with respect to market forces is increase deductibles so as to lower monthly premiums, or preclude certain treatments and procedures that are often the most expensive and potentially disastrous to both life and finances - also remediable

7. In an affluent society such as ours, there will be excesses, and extreme behaviors tend to incur health risks and poor overall health in general - this is remediable

8. Law suits are often frivolous - the biggest problem being that due to issues of reputation, exposure and the cost of legal fees, most doctors settle out of court - regardless of the prima facie validity of the complaint - this is remediable.

9. Over-diagnosis is typical, such that it is possible to delve into the potential pathology of even young people with such precision that illness without immediate consequence -such as mild type II Diabetes in a young adult are “detected,” with ramifications for premiums rates and frequency of testing, treatment and medical follow up - also remediable.

10. People are frightened by commercials and pharmaceutical ads into thinking they could “go any minute” and that fear drives up the cost of medical treatment and insurance premiums- also remediable

With that as backdrop, lowering cost simply becomes a function of resolving or eliminating some of those variables. (Here the malleable factors are designated by the term… “remediable.” By doing so, the extreme cost of the Obama plan and the income- limited Health Savings Account proposal by the Republicans can be replaced by a more empirical approach, which is as follows:

Reducing cost by controlling variables 3, 4, 6,7, 8,9 and 10

Regarding variable 3: Create a Government technology grant program to hospitals to help cover the cost of purchasing advanced equipment and related staff training. Medical facilities must apply for the grant and justify the need based on local population, other available medical facilities with similar technologies and other factors.

Regarding variable 4

: All doctors would be required to inform patients about the probability, not just the possibility of illness, before prescribing diagnostic procedures. In line with this, all patients should have access to a “Comprehensive Health Index“ evaluation, based not on the current high risk, moderate risk or low risk criteria but on correlation coefficients and percentiles. This index should take into account all factors that correlate with illness onset: including:

Age of individual

Family history of illness

Longevity of parents

Height

Weight

Blood pressure

Blood work results

Health advancing medications, that have led to symptom alleviation

Life style habits such as exercise routines, diet, cigarette and alcohol consumption Vocation, and o

From that Comprehensive Health Index, a patient’s likelihood of specific illnesses can be calculated to some level of probability - using available data from medical research and statistical analyses. Both physician and patient will pivot off that coefficient in discussing diagnostic and treatment procedures.

The Comprehensive Health Index would also be used as a criterion for standards of medical practice so that if physicians abstain from prescribing certain tests or procedures in accord with a low probability index, they cannot be sued, since the statistical criteria will be used as a Prima Facie standard for determining ostensible neglect or malpractice. All Writs, complaints and Defenses would be require to reference the index score. That, in concert with patient waivers, would decrease the occurrence of frivolous law suits and preclude the need for exorbitant pre-trial settlements.

Regarding variable 6:

All insurance companies, national and international will be allowed to operate in all 50 states to stimulate competition.

Regarding variable 7

: A rewards system for behavioral health practices will be implemented so that if a patient is charged certain monthly premiums based on health risk assessment, then subsequently improves his or her health status through medically verifiable outcomes such as weight loss, exercise regimens, dietary changes, reductions in blood pressure glucose levels, and other indicators ( as verified by a physician’s report) he can petition for a lower premium rate - regardless of the bald diagnosis. Any insurance company that refuses to reduce the rate based on a petition grounded in valid, measurable health improvements can be fined and/or made to pay equity to the patient and instate the reduction, retroactive to the date of petition.

Regarding variable 8

: Medical malpractice law suits would be capped at two million dollars unless there is evidence of intentional infliction of harm or recklessness. In addition, no Plaintiff will be allowed seek punitive damages unless there is intent or recklessness on the part of the medical practitioner.

Regarding variable 9

: Overuse of diagnosis procedures will be ameliorated by the Comprehensive Health Index. Since the patient will have a statistical coefficient at his disposal he can use that as an index of probable onset of illness and to determine the need for diagnostic procedures.

Regarding variable 10

: The fear factor will be ameliorated by disallowing commercials on television or radio by pharmaceutical companies on the need and use of medications, likelihood of illness and other inducements that scare people into seeking treatment. Since only physicians can determine the potential efficacy and harm of medications based on a thorough knowledge of the homeostatic functions of the body, only they should be appraised of the availability of these products.

Other measures designed to prevent the economic breakdown of the Obama plan and the limited effect of Health Savings Accounts are as follows.

Medical extension of unemployment benefits

A. Unemployment benefits will include health coverage during the time of unemployment. Individuals will have to adhere to the same standards, ie. seeking work regularly, having time limitations on medical as well as unemployment benefits. The applicant must apply, demonstrate that no other income is available to pay for health coverage (such as spousal income or other assets). The coverage will be temporary and at no cost to the applicant while he is unemployed and indigent but will be time limited

B. A bureau of Medicaid and Medicare will investigate the number of people eligible for medical coverage through either program who have not applied through an outreach program and enroll those who are eligible, based on current application review procedures. This will reduce the number of uninsured

Medical Self Administration Training

C. Finally, any person so interested can obtain training in basic medical monitoring and access to the purchase of medical assessment materials for blood pressure, urine samples, glucose and cholesterol levels and other indices of health status so as to practice a limited amount of self-help medicine. This program would be implemented and regulated by physicians and other medical personnel according to individual state regulations.

In summary, by:

1. Reducing the cost of medical technology for hospitals…

2. Developing an objective standard of health status so as to streamline the frequency of diagnostic and treatment procedures via objective statistical-based risk assessment…

3. Expanding competition through all inclusive state policies on insurance companies…

4. Giving patients control of cost through a reward system based on improvement of health status…

5. Capping lawsuits except those involving intent or recklessness…

6. Alleviating the scare factor by drug companies attempting to sell products through the “possibility of illness scenario” by precluding advertising medications to the public…

7. Adding temporary health benefits to the unemployed/indigent, by rewarding appropriate health practices through rate lowering petitions, reducing the need for diagnostic and treatment procedures…

8. Developing a state-run medically-approved Self-Administered Diagnostic Skills Program so as to preclude the need for excessive medical follow-up and provide patients with the impetus and information by which to make decisions regarding the need for medical procedures… the cost of health insurance can be substantially reduced, control over health status and therefore premiums by patients would increase, and unnecessary law suits, diagnostic procedures and treatments could be obviated.