SUMMARY

Our country is experiencing a crisis in health care delivery because medical progress has overwhelmed fair distribution of this progress to all segments of society. If medical science had stopped about 30 years ago and many recent advances in care had never existed, we would not be in our current dilemma. We face a choice: either we fundamentally change the way we think about health care, or we stop progress.

The insurance model of care delivery, originally established to insure risk, has evolved into a prepaid basket of benefits. The range of benefits is extensive - a visit to a doctor for a flu shot and heart surgery can be included in the same policy. Because the variety of benefits is constantly increasing, the prepaid, packaged price must also increase. More people are uninsured because the cost of policies available to them has exceeded their budget. The dilemma of the uninsured is the result of too much progress.

In Canada and European countries, attempts by the government to mandate medical care to all c~tizens have resulted in long waiting lists, overextended budgets, and lack of availability of the most current treatments. A profound change in the way people regard medical care is necessary. People must stop thinking about health care as a professional service, and view it instead as a consumer item. This change, which must take place in the attitudes of millions of people, will be the most difficult part of meaningful health care reform. The concept of packaged care with a co-payment, of special arrangements between insurance companies and providers, must be replaced by complete consumer control of a major portion of health care.

Health care should split into two parts: I) clinic care; 2) hospital care. People will pay for clinic care themselves, using funds that they accumulate through tax-exempt accounts. Under this outpatient self-insurance model, people will serve as their own managed care organizations. They will directly control the rationing of their care, which is an inevitable result of continuing progress. These new clinic care consumers will learn to shop for health care as they do for cars, computers, and cameras. People will learn to think about clinic care as they think about food. A large variety of foods are available in grocery stores; people pay directly at the point of sale, and consumers know how to compare quality and cost. In addition, the government has food programs for the needy.

Hospital care will be paid for by insurance policies, similar to the way hospitals are paid now. However, these streamlined policies will be about 60% cheaper than current insurance policies. Millions of people who are currently priced out of the insurance market would be covered for serious illness. Medicaid hospital insurance will cover the unemployed needy; Medicare Part A will cover working people who are uninsurable on the private market.

Another reason to abandon the insurance model for all of healthcare is that advances in genomics research will shortly make medical insurance obsolete. In a few years, computer technology will predict a person's individual risk for getting a particular disease, using information that exists in a single cell, in just minutes. The idea of insurance is a shared risk pool. If an insurance company knows the individual disease risk of people that want insurance, many policies would automatically exclude people and also be astronomically expensive. The health insurance policies that currently exist and the genomic revolution are mutually exclusive.

This report is divided into three portions: I) how to bring about a change in consumer attitudes about health care using a media campaign targeting the uninsured. 2) proposals for Federal legislation to facilitate the consumer-driven model; to provide financial back-up when people exhaust their own funds for clinic care, and for basic universal hospital insurance. Revisions for Medicare and Medicaid will also be presented. 3) proposals for changes in public education about health care and training of medical professionals. After all three sections, the Terms and Conditions of the contest and the Health Care Magna Carta will be reviewed in the context of the ideas presented.

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