The American Way

For many years America has had a health care system where even though, theoretically, everyone has access to basic health care, not everyone is in a position to be reimbursed for this care. This leaves those millions without health insurance hesitant to go for needed care because of the financial responsibilities and repercussions that getting care could entail.

This leaves much of the population playing Russian roulette with their health and often losing. When the uninsured "lose" it ends up costing all of us money. Their unpaid healthcare expenses eventually trickle down to all of us and the personal bankruptcies that are generated from unaffordable health care bills hurt the economy in general.

The United States has come to a point in its moral evolution where citizen access to reimbursement for basic health care is something that can no longer be classified as a luxury. It is quickly becoming both a moral imperative and a fiscal necessity. As the health of its citizens is also an important factor in the health of an economy, universal insurance for basic health care is also something that makes fiscal sense.

As such, the need for some plan that permits this country to guarantee at least basic health insurance to all of its residents has come of age. The real problem was in designing a plan that provides this Basic Care to everyone while at the same time guaranteeing a climate where excellence and innovation, which are direct results of a free market, remain vital. Excellence and innovation are what have consistently kept this country on the vanguard of cutting-edge medicine.

The free market works because those who provide new and good products at a good price are rewarded (i.e. sales and therefore profits) and those who provide a less than optimal/dangerous product or overprice a good product eventually go out of business because of lack of saleslprofits. Visionary thinkers and entrepreneurs try new things and take personal risks to generate profits while society in general benefits from the new products and from the jobs created in the process of generating the profits.

I have designed The American Way to permit profits for innovation and excellence while still guaranteeing basic reimbursement for all individuals. There are incentives for all who use the system to use it wisely as well as incentives for those who provide services to provide the highest quality services possible. There are built in incentives for things such as preventive care, motivations to not utilize with abandon, guarantees of professional autonomy, individual choice and much more.

The promise of a reward is a significantly better shaper of behavior than the threat of a punishment. Rules and regulations usually threaten punishment whereas incentives promise reward. Therefore, to be successful and to work over time, The American Way has strong incentives for appropriate behaviors built into it. These incentives target all of the players in the system: the individual, the professional and the institutions and the businesses that provide the services. Rules and regulations are geared towards increasing rewards rather than towards punishment for abuses, and punishment for abuse of the system are in the background.

The incentives built into The American Way will hopefully make the system work. Regulation alone has failed to show itself as a strong enough force in controlling behavior to permit us the luxury of continuing to believe that rules and regulations alone will take care of the potential for exploitation of any system. Human nature is such that many who see regulations look at them as challenges to find a way around them -challenges to achieve personally at the cost of others and of the system.

We currently have an army of "fraud detectors" invading the privacy of patients and professionals looking for abuses of the system. These kinds of tactics, although effective to some degree, cost so much in personal liberties that the end result is worse than the wrong it is trying to right. Professional judgment, based on years of experience and training, can often fall to the rules of a system based more on fear of punishment for innovation and on fraud prevention than on quality of care. And when quality of care suffers the system is broken.

Our current system is also broken because, under HIPAA, privacy of personal health care information, although seemingly more protected, has actually been usurped with no consent for disclosure to a vast majority of entities being the norm. In The American Way we return to a place where our most private of information is totally under our control so we will be free to seek treatment for whatever is ailing us without fears of repercussion.

People and institutions are remiss to change, so implementation of The American Way is such that there are rewards for changing behaviors. Changes in our tax code are called for so that our current way of providing health insurance, through the employer or through the union, is eliminated with rewards for both the institutions and the individuals as they are changing their ways. Tort reform is also called for so professionals can practice medicine with the needs of the patient taking precedence over fear of litigation.

Unless all the players feel good, in some ways, about changing, successful sustainable change will not occur.

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