It would be good, before we start listing proposals to overhaul our American healthcare system, to state exactly what we wish to accomplish with any proposed changes. Myself, I do not want a clone of the British healthcare system, the NHS (National Health Service), transcribed on to our American system. Why? Because the government interferes with the practice of medicine there, because the British tolerate significant waiting lists, and because I do not want to be beholden to our government so that I can get up and go to the doctor, when I feel a need to do so. I really don’t like being bribed with my own money, which is exactly what the politicians do to the American people.
In America, those, who can afford it, are dependent upon insurance companies, with their ever-increasing premium and deductible payments coupled with other dollar-garnering mechanisms, for health care coverage. So, before any doctor or hospital visit, comes the question, “Have I met my deductible?” This is another roadblock as palpable as a waiting list. Those, who cannot afford health insurance, become, in one way or another, part of an Entitlement population, which carries another whole load of problems, including easily recognized discrimination, anger and dejection at being disenfranchised, and more ideological cover for increasing insurance premiums and deductibles via the purported cost shift mechanism, ensuing because of inadequacy of public payments for the entitlement populations.
It appears to me that both the British and American systems have a central control mechanism designed to block people from receiving advanced medical evaluation. In Britain, it is the government; here, it is the insurance companies. What is their motive? In Britain, it is the British pound and in America, it is the dollar bill. In America, if you have enough money, none of this affects you. You can override the insurance company roadblocks because you can meet their price.
How can we create an American healthcare sytem, which dispels these realities? I think the core principles that the British started with in 1948 can point us in the right direction:
1. That the system meet the needs of everyone
2. That it be free at the point of delivery
3. That it be based on clinical need, not on ability to pay.
I think these three are wonderful goals. The trouble that I see is that neither the Americans nor the British have figured out how to accomplish them, while making sure that superb, advanced medical care takes place without bankrupting individuals, companies, or the country. In a series of posts on this blog, I intend to discuss each of these core principles and mechanisms for their achievement, which will not only control healthcare expenditure but also keep healthcare businesses and providers economically stable and satisfied.
R. Garth Kirkwood, MD