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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Johnathon S. Ross, MD, MPH, St. Vincent Mercy Medical Center, Toledo, Ohio, 2213 Cherry Street, Toledo, OH 43608, 419-251-2360, jross59627@aol.com
A single comprehensive insurance plan covers all Americans with no restrictions on choice of care provider. Coverage includes all standard medical benefits with no deductible or co-payments. Benefits remain in place through moves, job changes, unemployment, retirement, or chronic illness. Americans never lose coverage. A single payer replaces the existing myriad of health insurers. Immense administrative savings derive from eliminating the bureaucracy, duplication, marketing costs, and profits of these companies. Multiple studies demonstrate these savings allow universal comprehensive coverage. Personal and payroll taxes replace insurance premiums to finance the plan. 90% of Americans would pay less. Yearly negotiations achieve cost control by creating a balanced national health budget. A single intermediary, under stringent national standards, negotiates hospital budgets, capital expenditures and physicians fee schedules yearly. Patients receive no bills. The single intermediary directly reimburses providers. Single payer financing allows providers to choose their specialty. However, financial incentives are easily shifted to achieve desired goals, e.g. encouraging primary care practice, location in rural, central city or other under served areas. Improved funding of the public health infrastructure would pay for itself in savings. Medical school scholarship support could lower the debt and improve the opportunities for students from modest or low-income families. A single payer simplifies central gathering and interpretation of health care data. Improved outcomes should result when this information is shared for quality improvement rather than hoarded for competitive advantage. Coverage for the uninsured should significantly improve health outcomes for nearly one in six Americans.
New system structures will be needed but many other administrative overheads will disappear. Publicly accountable regional health boards with community representation must be created. They will set budgets for new services and facilities, negotiate payments and support tax levies that are adequate to fund the system, contract with a third party intermediary to process bills and collect needed data for financial analysis and quality improvement, review quality data and give care giving professionals incentives for improvement. No new structures are required to raise the money as income or payroll tax systems already exist. The health care dollars need to be earmarked (e.g. the Medicare trust fund) and funded into the future. Health care needs often rise with a fall in the economy and reserves held in trust smooth out these ups and downs.
Learning Objectives:
Keywords: Health Care Reform, Universal Coverage
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.