My figure, Structure for American Health Care with Central Payer (please study it), reveals several basic, common sense understandings, which I believe are critical for successful health care reform. Without these basic concepts guiding the actions of the central payer, it will turn into a debacle like the implementation of Obamacare and into a socialized system that imposes waiting lists and other obstructions to the proper practice of medicine. These understandings are as follows:
- Dollars from the American people support the entire system. These dollars belong to the American people and not to the central payer and not to the politicians or government. The politicians should have ZERO access to this money.
- A 2 trillion dollar fund (? > $2 trillion) will have to be created annually, located such that it is under the control of the central payer (and forever untouchable by any politician in any branch of government including executive order from the President), and used for the payment of everyone’s entire medical bill including medicines on an ongoing basis without co-pays, deductibles, or the nonsense of covered-uncovered care.
- The monies from this fund will be distributed by the central payer to necessary health care businesses. Not all businesses, which have health care as some part of their mantra, are necessary for the proper practice of medicine. Indeed, some are detrimental to this.
- The interaction of the central payer is with the necessary health care businesses only (not lobbyists, not medical organizations, not political action groups, etc.). The central payer should have no access to the doctor patient relationship, either direct or indirect. I think direct is easy enough to understand. No person in the central payer should, in any way, be able to influence or directly interact with the functioning of doctor patient relationships except for those in which they are the patient. Indirect is a little more difficult to grasp. An example would be not funding a procedure or trying to dictate, regulate, or even suggest when or how often a procedure should be performed. The central payer’s role in the health care system is to pay the bill for the work, defined by and completed within the context of doctor patient relationships, of the health care businesses which participated in that work. Its job is not to determine what that work is.
- The stance of the central payer regarding the business negotiation of price paid for service and product must be one that ensures that necessary health care businesses remain financially sound for daily operations and generate substantial annual profits, which are clear and transparent. I believe the American people would welcome this, and I do not believe that they want to see their superb necessary health care businesses bankrupted by a central payer.
- The entire system exists to achieve clear and equal access to sound, ongoing, non-conflicted doctor patient relationships for everyone living in America without bankrupting people in the process. Doctors and patients need to comport themselves so that these adjectives, sound, ongoing, and non-conflicted can be readily ascribed to the functioning of this equilibrium of trust, , which must exist between them.
R. Garth Kirkwood, MD