O'CONNOR CONTEST-FOR A BETTER HEALTH CARE SYSTEM

Executive Summary

In addressing the conditions on page 2 of the contest rules and the ten principles of the Health Care Magna Carta, we should recognize two guiding precepts: the need for simplicity and the importance of balance. As medical science learns more about our ailments and how to treat them, the art of improving health and curing the sick becomes ever more intricate. This burden is heavy enough without adding needless complexities.

Funding: It is far simpler to have "the same risk pool" for a11 "health services" (Magna Carta items 6 and 9) rather than "smaller segments" dealing with "specific health categories." While "no person should face bankruptcy" (item 4) we all "should pay for it" (item 2). Foes argue we can't afford it. In truth, because their costs and profits under our Rube Goldberg non-system waste over $300 billion a year we can't afford not to.

Source of funds: 50% Federal payroll tax (1/2 employer, 1/2 employee like part A Medicare), 35% Federal general funds, 15% from veterans, workers comp and patient copay. Cost savings should cushion the cost impact of this by over $300 billion. We should study not just present sources ($705 billion government, $530 billion private insurance, $280 billion other private) but also other countries, both their problems, such as led to the Swiss referendum of May 18,2003 on funding and governance, and their solutions.

Profit by the Experience of Others: In truth the chief thrust of our proposal is to spend $15 million (what we now spend on health care every 5 minutes) to see what other countries have done right to have lower infant mortality and longer life spans than we at much lower costs, from 65% of ours (Swiss and German) down to 35% (British.) Just as the individual "must participate in health care decisions" (item l), "all persons should have access" (item 3) through a doctor of their choice and participate in a "dialog to define the goals of a health care system" (item 10) based on knowing what works.

Balance: Use reimbursement to improve cost control and quality for all. Many systems (DRG, RCC, UCR etc,) have been tried, but a single system properly crafted and overseen can minimize gaming and overuse, while avoiding problems such as the waiting lines of Canada, transplant non-availability in Britain, too much Rx prescription and long hospital stays in Japan and Swedish problems in implementing facility planning.

Central Standards and Management: (Item 8 and #8 of Conditions) Non-profit intermediaries under strict Federal oversight as in Medicare with its 2 to 3% overhead.

Savings: Will come fiom the elimination of private insurer overheads of up to 25%, similar waste by the drug companies, defensive medicine arising from liability laws "a gantlet of satellite businesses insurance brokers, disease management and utilization review companies, lawyers, consultants, billing agencies, * and so on." (Marcia Angell)

Interests of Stakeholders(#s 2,6,7,9 of Conditions): While tort reform will appeal to most physicians as will codinglpayment simplification, the savings just listed will be poison to powerful vested interests which now take these funds, our money, for their profit. They will fight like cornered cougars to keep the status quo, and will deploy enormous resources in lobbying and PR skills to paint a picture of disaster, of huge tax increases, of endless waiting lines for service, of faceless panels of doctors and of bureaucratic bunglemess. That's why we must keep the plan simple and not expose it to the flak which sank the Clinton plan in 1994. Migration should move in stages, with ongoing evaluation of health care changes and $ concessions likely to win the favor of large employers who are currently paying huge sums for coverage of their employees.

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