Friday, June 18, 2010

How to Fix the U.S. health care system...at least partly

Anybody that claims that they have the solution to the U.S. health care dilemma is crazy.  I won't try to provide a secret recipe for health care reform, but I do think that there are some important facets of other health care systems around the world that should be implemented into our own system.

1) Insurance companies should be prohibited from making profits off of peoples' health.  Shareholders?  Gone.  Their primary function must be to keep people healthy.  There really isn't any way around this.  Health care costs money, so when you deny people coverage, you conserve more of it for your shareholders.  This must end, no questions asked.

2) Insurance companies can't refuse coverage based on pre-existing conditions.  In fact, they shouldn't be able to refuse coverage to anybody, period, if that person is willing to pay them for insurance.

3) To make sure that people don't abuse #2, everybody that can afford it must pay into insurance.  If everybody pays, then premiums are lower because costs are distributed across a larger population.

4) It should be illegal for pharmaceutical companies to spend so much of their budgets on marketing.  Currently, U.S. pharmaceutical companies spend about 24% of their budgets on marketing their drugs, which is over ten percent more than they spend on research and development.

5) A special advisory commission comprised of health professionals should negotiate all prices for any procedure, treatment, drug, test, and other health care service. These prices should be fixed nationwide for any patient, provider, and insurance company.  Insurance companies should focus on expanding their client list rather than on finding reasons to deny reimbursement to their clients.  Since prices are fixed, they have to pay no matter what, so they'll increase their income by enticing more people to sign on with them, and then by keeping those people healthy.

6) Prevention should become our primary objective.  This includes improving access to locally, sustainably produced food; better public health regulations (e.g. reduced air pollution, access to safe drinking water, vaccinations); steep taxes on all processed foods except restaurants that meet certain established dietary guidelines; steep taxes on cigarettes and alcohol; the encouragement of tests and screenings for cancer, diabetes, cardiovascular disease, etc.; and improving access to fitness facilities and programs.

7) Taxes collected from processed foods, cigarettes, and alcohol will help to fund health insurance for those below the poverty line, senior citizens, veterans, military personnel and their dependents.

8) A separate advisory committee established by the government should make recommendations for which screenings and test should be done on which populations and how often they should be done to produce the best results.

9) Physicians must regain the power to choose whichever treatment they see fit for their patients.  The commission suggested in point #5 will outline a fee schedule for every treatment imaginable (as long as they see a benefit in covering it), and the physician may choose whichever drug or procedure that they think would be most effective.

10) Medical schools should be free to the student.  In 2009, the average debt incurred by U.S. medical students was $156,456.  This is the figure achieved after graduation.  Add on 15-30 years of interest, and you're looking at a second mortgage on a very fancy house.  It's simply too difficult to pay off medical school loans on a primary care physician's salary.  If school was free, many more people would choose fields in internal medicine, which is currently desperate for more doctors, and which also happens to be the field in which prevention could reign supreme.

11) The USDA needs to revise its dietary guidelines, and these guidelines should be followed strictly in our schools.  Even with the recent 2006 USDA Food Pyramid Revision, it's suggested that we eat more carbs than necessary and not enough healthy fats and protein.   Processed carbohydrates should be forbidden on the food pyramid.  All of the carbohydrates that we need should come from fruits, vegetables, nuts, and legumes, as far as I'm concerned.  Soft drinks, candy, and pastries should absolutely not be allowed to be served in grades K-12.

12) Government subsidies should be reserved for organic produce and raising free-range, hormone-free, grass-fed livestock.  Evidence for the health benefits grass-fed beef and dairy; free-range poultry products; wild fish; and organic produce is overwhelming.

13) Brace yourself for this last one.  Every U.S. citizen needs to start taking personal responsibility for their health.  While there is probably some connection between genes and disease, the diseases that are most taxing to our health care system (those associated with metabolic syndrome) can be largely avoided through a healthy diet and frequent exercise.  Get your kids outside rather than buying them electronics to keep them busy.  Get yourself outside with your kids!  If you are young and feel healthy, start incorporating regular exercise into your life to maintain and improve your fitness.  The most important thing that we can all do is to educate ourselves about food.  Cook your meals at home rather than resorting to fast food every day, and slowly incorporate more produce into your diet.  Lastly, take it on yourself to pressure the government and school boards to fix the school lunches and physical education programs at your local schools.  There are countless things you can do to live a healthier life.  You know what to do.  


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Considering the huge disparities in our nation's health when compared to other developed countries, it would be absurd to think that we can't do any better.  Our health care expenditure is nearly twice the next highest in the world, yet we get shockingly poorer results.  Health care costs continue to rise faster than we are able to accommodate them, due to constantly improving technology.  The most important reason to reform ourselves drastically is that people are dieing from diseases that were entirely avoidable in the first place.   When people do get sick for fault other than their own (e.g. genes, accidents, and natural disasters), we should have a system in place to help them out. 

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