American Health Care: Common Sense

  1. that everyone living in America be able to go to the doctor at his/her discretion without the daunting fear of not being able to afford it;
  2. that everyone living in America pay for health care, whether they have a job or not. Employers not to be responsible for this personal responsibility. Labor unions have no say over individuals’ health care;
  3. that health care be free at the point of service;
  4. that decision making regarding an individual’s health care belongs solely to the non-conflicted, spontaneous, ongoing, and sound functioning of the doctor   patient relationship;
  5. that the payer of the bill, i.e., the entity which administers payment of the bill, has that one function and no other;
  6. that the payer of the bill be a central entity set up by Congress but which remains autonomous from the Congress and from all lobbyists, i.e., in a fashion similar to our Supreme Court. Note, if we cannot find honest, trustworthy people with the same degree of integrity and the same degree of knowledge regarding the different aspects of our health care system as the justices of our Supreme Court possess regarding the law, then our country is doomed;
  7.  that medical coding for administration of payment to doctors be greatly simplified:
  • a) office visits,
  • b) hospital visits,
  • c) consultations,
  • d) invasive procedures;
     8. that billing and payment be greatly simplified:
  • a) doctors dictate a note regarding the service provided (office visit, hospital visit, hospital consultation, hospital discharge summary, procedures both inpatient and outpatient),
  • b) the note is submitted electronically by the doctor to the payer; the note has two functions: 1. to act as a bill, i.e., once the note is received, automatic payment is generated to that doctor and/or hospital and not before 2. to be an ongoing part of the patient’s medical record,
  • c) the central payer’s function is to administer payment to doctors and hospitals, not to determine the quality of or the necessity of any visit or procedure. Quality review is done locally;

9. that the following entities, concepts, and thinking be removed from our healthcare system because of the disastrous, greed-driven business manipulation, which they have brought with them:

  • a) health insurance companies,
  • b) generic medicines,
  • c) the words, indigent, poor, unable to afford it,
  • d) Medicare, Medicaid, public versus private programs, not-for-profit, and for-profit,
  • e) primary care,
  • f) medical homes and accountable care organizations,
  • g) hospitals and medical centers paying doctors’ salaries,
  • h) the current system of malpractice lawsuits,
  • i) physician entrepreneurship,
  • j) outrageous hospital administrator salaries and hospitals using health care to  become independent business fiefdoms;

10.that patients and/or families be responsible for end of life care decisions via advance care directives within the context of the doctor  patient relationship for that patient;

11. that doctors and patients have one goal in our health care system: fulfillment of their responsibilities for creation of sound, ongoing, non-conflicted doctor  patient relationships;

12. that ridiculous rhetoric such as, a central payer automatically means socialized medicine with all its attendant problems, be recognized for what it is. Our health care is already socialized (meaning controlled, obstructed doctor patient relationships) by both private and public payers. Setting up a central payer with honest, knowledgeable people, who understand the needs of health care businesses including doctors’ practices while maintaining complete independence of the doctorpatient relationship from those businesses, is what we need in America. Moreover, the concept that states should be involved in this is just foolishness: Another 50 sets of slime ball politicians dipping their hands into the healthcare gravy train.

13. If we do not have the wherewithal in America to set up a properly run central payer, while keeping medical practice free of influence from that payer, then we are in serious trouble. Obamacare is just another in the long list of garbage political–business schemes, which will further us along the way to a completely socialized country, in which, because of redistribution of wealth, those who pay taxes and who buy insurance will pay for the health care of everyone and in which the health care will be delivered from some protocol written under the influence of business people and politicians.

R. Garth Kirkwood MD

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