Executive Summary

The American health care system is an enormous complex of government and private health care service and goods providers, payers, insurers and regulators who collectively determine what members of society are going to get health care, how much that health care is going to cost, and what segments of society are going to pay for it. Most industrialized nations view health care as a public good to be funded and regulated by government. The United States, with its tradition of less reliance on government and greater reliance on individuals, regards it as another aspect of private enterprise. When the population was small, when there were few diagnostic tools and even fewer remedies, and health care consisted of a private transaction between physician and patient, this system worked. The explosion in knowledge and technology in the twentieth century irrevocably altered the nature of health care, changing it from a personal business transaction between two parties to a hybrid government 1 private enterprise industrial complex accounting for nearly fifteen percent of United States GDP. There is general agreement that in its present state, it does not work well. The United States lags behind the largest industrialized nations in health of its population as measured by the leading indicators of life span and infant mortality rate, while at the same time paying much more per capita for health care than any other country in the world. Federal and state governments are working on a myriad of conflicting proposals that address issues of cost, access and quality but appear to do little to improve health and instead further increase the fragmentation and complexity of the system.

Albert Einstein said that "everything should be made as simple as possible, but not simpler." Providing health care to a diverse population of almost 300 million is not a simple task, but it can be much more efficient and equitable, and certainly less complex and costly. The ideal health care system is one that is based on health instead of on access to health care and makes individuals ultimately responsible for their own health. Health is not a commodity that can be purchased, and the role of a health care system is not to provide unlimited access to health care but rather to help individuals achieve health as defined by the WHO - a state of complete physical, mental and social well-being.

My proposal for a health care system is based on the premise of individual responsibility for health, the tenets of the Health Care Magna Carta and the medical profession's ethical principles of autonomy, beneficence, nonmaleficence and justice. Autonomy is defined as self-determination - patients and their agents are expected to be involved in all decisions regarding health care; beneficence is the duty of providing benefits and maintaining a balance between benefit and harm; nonmaleficence is the duty to do no harm; and justice is giving each individual his or her due. By using these principles, the result will be a health care system that will provide all citizens with access to the tools they need for good health, at a price they can afford. The health care system as I envision it will be a single-payer, universal coverage system financed by taxpayers, and regulated by the federal government, and administered by the states. It will include a set of services including traditional and alternative preventive, chronic and acute physical and mental care, long-term care including home health services, pharmaceuticals and other necessary medical devices, and basic dental services. Everyone will be in a single risk pool, and all health care will be reimbursed through a single pool of funds. Individuals will no longer be classified by age, employment status, economic or ethnic status, and ailments will no longer be classified as work-related, accidentrelated, pre-existing condition, as a result of malpractice, etc., with care and funding dependent upon these factors. Everyone will have access to the same set of services at an affordable price. Preventive health will be emphasized, and the health care system will actively deal with issues that compromise health, increase cost, and reduce access and quality. Health outcome, instead of health access, will be the focus, responsibility for health will be placed back on the individual, where it belongs, and the health care system will be a support system instead of an ever-expanding entitlement program whose constant growth has not improved the health of the population and has instead consumed resources to the point ofjeopardizing other social needs.

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