The O'Connor Competition: Building an American Health System
Executive Summary

This report is divided into three sections: 1) analysis of current health system problems, 2) suggestions for a new system, and 3) how this relates to the health Magna Carter.

The current problems are due to a system designed to treat acute episodes of disease rather than to prevent or delay the onset of chronic diseases, which consume 80% of health expenditures. Health care is designed to provide disease cures isolated from the non-medical causes of disease, which are primarily poverty due to lack of education and life skills. Although many people believe that fee-for-service, malpractice litigation, high hospital and drug charges, insurance companies profits, and expensive administration overheads are the causes of the US health systems failure to provide cost-effective equitably distributed care, they are exacerbating factors but not the cause. The principal cause is the failure to have an effective disease prevention, health promotion system designed to operate at the community level with the patient being trained to be their own self-care expert. By developing a self-care approach to disease prevention1 management it has been shown that health costs decrease from reduced patient demand without sacrificing quality of health care.

The proposed new system has two separate parts. The first is designed to raise single parent families out of poverty into jobs paying at least 1.5 times the federal poverty level with the potential for increased earnings. One suggested model is based on combining a vocational training with health education in a "village" attached to a nursing home. The ' villages are run by not-for-profit companies, with mothers achieving a Licensed Practical Nurse qualification after two years. The following three years they work in the nursing home to pay for the first two years of food, accommodation, clothing, day care and training. Part of the funding is from existing federalfstate grants, such as training, and part from the company. If only 500, out of a total of 17,000 nursing homes, establish "villages" they could train 50,000 single parents over five years with 150,000 children in a healthy environment.

The second proposal is to develop a comprehensive national health care plan to cover the current Medicaid, Medicare, and uninsured populations, using existing public health expenditure levels. By combining capitation plans with community based disease prevention, patient self care leading to reduced care from demand management, it should be possible to cover 50% of the population. Current privately insured people would have the choice of purchasing cover with the national plan. In this way the cheaper better national plan would compete in the private sector but employers and individuals would retain the choice of public or private insurance.

Estimates of cost are provided for developing these concepts further. To test the vocational "villages7' in five states over five years requires $14,000,000. To develop a detailed plan for comprehensive cover for 50% of the population, within existing public expenditure levels, will require $1,000,000.

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