Core Principle for American Healthcare System Reform: Free at the Point of Delivery–YES; and Everyone Contributes to Its Financing

Free at the Point of Delivery is a good concept. It simply means that there is no exchange of money or other forms of payment at the doctor’s office, hospital, or pharmacy. The dollar bill or lack thereof should no longer be an obstruction to anyone going to the doctor, when they decide that this is necessary, or going for specialty diagnosis and treatment including surgery, when this clinical decision has been made within the context of the individual’s doctorpatient relationship.

For effective healthcare reform, the dollar bill must not be an obstruction, a hurdle to be cleared, before we can avail ourselves of the wonderful strengths of American health care. Thus, the concept of deductibles, co-pays, and cash out of pocket need to disappear from our healthcare thinking and lexicon.

This does not mean that health care is free. Nothing is free in America. I believe that everyone should contribute to the financing of our American healthcare system. If the system is to meet the needs of everyone, then everyone should have a financial stake in it. I will discuss ideas for this financing in future posts. But it is my view that this financing should not occur at the point of delivery. That makes financing our system an obstruction to accessing it as opposed to an appropriate vehicle for guaranteeing its existence and quality.

R. Garth Kirkwood, MD

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