A New Paradigm for The Public's Health

Executive Summary

We propose an American health care system that is based on four essential principles

First, each American citizen has a fundamental right to medical care, available to all just as police protection, electric power, water, state and federal highways, and public education are available. Access to essential medical care should not be a benefit granted by one's employer, or an entitlement based on one's age, economic status or medical condition.

Second, control of delivery and financing of American medical care is too important to the personal health of its citizens to be left to the experts: whether medical professionals, managed care organizations, employers, or the federal government. Medical care should be governed by the people and for the people at a fairly local level of government.

Third, citizens should move from the periphery of our health care system to the center of the system, a center now dominated by private payers and private practitioners. This change is most effectively accomplished by organizing essential medical services as a public utility.

Fourth, the public medical care system should be organized and managed in order to:

1. Recruit and retain health care professionals whose priorities are high-quality and compassionate medical care;
2. Remove the financialladministrative elements in the current system that impede quality, (e.g. establish service-neutral provider compensation; replace fault-based malpractice system with no-fault system); and
3. Support these professional caregivers in continuous quality and service improvements.

This public medical care system is not a national health insurance model, but is based on a governmental initiative older and more successful than Medicare: American public education.

We propose that our country establish a health care system modeled after our education system. Everywhere in America, communities would fund and operate public medical care systems, making essential medical services available to all citizens. This system would be required under coordinated federal, state, and local laws, be funded primarily by state taxes, and be governed by local and state boards. The public medical care system would guarantee citizens access to basic medical, diagnostic, hospital, pharmaceutical, dental, behavioral and rehabilitation services-at little or no cost. Beyond these services, individuals would be free to use their own personal funds to purchase additional health services (e.g., health promotion, wellness counseling, performance enhancement) from private practitioners and programs. But everyone would pay into the public medical care system: citizens, businesses, and all levels of government.

We present the rationale for direct consumer control of both the delivery and financing of core medical services. We explain how this consumer-centric model effectively balances stakeholder interests with stakeholder responsibilities. We argue that the American public may be ready at this historical time, after seventy years of private-payer, private-provider dominance, to consider trusting their health care to their own American democratic process. Build An American Health System Contest Copyright 2003

Contest to Build an American Health Care System: A New Paradigm for the Public's Health

Introduction

We propose a health care system that is based on four essential principles.

First, each American citizen has a fundamental right to basic medical care, available to a11 just as police protection, electric power, water, state and federal highways, and public education are available. Each citizen deserves equal access to essential medical care; basic medical care should not be a benefit granted by one's employer, or an entitlement based on one's age, economic status or medical condition.

Second, control of delivery and financing of American medical care is too important to the personal health of its citizens to be left to the experts: whether medical professionals, managed care organizations, employers, or the federal government. Medical care should be governed by the people and for the people at a fairly local level of government.

Third, citizens should move from the periphery of our health care system to the center of the system, a center now dominated by private payers and private care providers. This priority shift will be most effectively accomplished by organizing essential medical services as a public utility.

Fourth, the public medical care system should be organized and managed to recruit health care professionals whose priorities are high-quality, compassionate medical care, to remove the financialladrninistrative obstacles to quality in the current system, and to support medical care providers in continuous quality and service improvements.

We seek, as others have sought before us, to ensure that all Americans have guaranteed access to essential medical services. Most advocates of universal coverage propose national health insurance: an expansion of the federal Medicare program for the elderly to include citizens of all ages. This approach has certain advantages: a) the political simplicity of expanding a recognized and popular entitlement program, b) national uniformity, and c) standardization of servicesladministration across jurisdictions.

Our proposed model differs in several fundamental respects from both a national health insurance model and from the current system (which is a privatized system with public and private financing). Our approach does not tinker with benefit mandates or offer tax incentives to healthcare stakeholders to change their behavior. It is grounded instead on concepts of social utility and public safety applicable to all citizens. Our model utilizes the framework of a local government initiative much older and more successful than Medicare: the American public education system.

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