Having spent 25 years as a hospital executive, I've seen the country's healthcare system from two perspectives: as healthcare chief executive officer and as a consumer of healthcare.
There is a lot that is right with healthcare in the United States. Our country is home to some of the finest doctors, nurses, medical facilities, and allied health professionals in the world. And yet, health outcomes in the U.S. do not live up to the national wealth in terms of medical resources.
The truth is that the best medicine in the world doesn't do much good if people can't access it. In a 2016 survey of eleven countries by The Commonwealth Fund, the U.S. ranked last in terms of adults who "faced cost-related access barriers to care in the past year." The study also noted the high percentage of Americans who have trouble accessing healthy food in addition to healthcare.
Here are six changes to our current health care access system that I believe would transform healthcare access in the United States:
1. Pay physicians, hospitals, outpatient facilities, etc., for keeping patients healthy rather than treating them when they're sick.
Healthcare providers would then compete for agreed-upon payments for keeping their enrollees healthy and no longer generate revenue by performing procedures.
2. Raise the penalty for those who do not acquire health insurance.
As it stands, the cost of health insurance exceeds the penalty for not having it. There is little incentive for healthy individuals to insure themselves, and that undermines the fundamental premise of risk-spreading on which insurance rests.
3. Eliminate, or alter, the employer-based system of purchasing insurance.
The main reason Americans have health insurance from their employers is because during World War II, the National War Labor Board froze wages. Offering benefits like health insurance was a way to get around the law to keep attracting and retaining scarce employees. If employers would agree to increase employee salaries by the total amount they are currently paying for the health benefits, both sides would benefit. Employee salaries would dramatically increase and the employer burden of providing health insurance would be eliminated.
The culture of Americans expecting someone else to pay for their healthcare removes their responsibility for improving their own health. We all need to assume responsibility for our health. Separating health insurance from jobs would also help to reduce "job lock." The work force would have greater mobility and small businesses would gain competitive edges against large corporations.
4. Avoid the highly expensive malpractice cost of physicians and providers by establishing clinical best practices.
If a physician or nurse practices per clinical best practices, lawsuits could be greatly reduced and we would eliminate billions of dollars of ordering so many unnecessary tests. The need for "defensive medicine" would cease.
5. Eliminate the Medicaid program currently funded by both the federal government and states.
Most physicians don't accept Medicaid patients – only 67 percent of non-pediatric primary care physicians accept Medicaid as a form of payment, while 93 percent of primary care physicians accept Medicare. This would dramatically increase access to high-quality medical care for all, especially the 74 million enrolled in Medicaid/Children's Health Insurance Plan (CHIP).
6. Consider a law that makes Medicare the provider of health coverage for all Americans, with copayments based on individual income and/or employer direct contributions, like a pension plan.
Everyone will need to contribute to pay for a national Medicare system for all, but with higher salaries and less interference in the physician-patient relationship, everyone will benefit.
Some of the world's wealthiest people travel to the United States to receive medical care. I believe that it is possible – and highly desirable – for these resources to be available to Americans, regardless of their economic status. The steps above, while challenging, would go far in bridging the divide between the country's world-class health care and the Americans who need it.
Dennis C. Miller is a nationally recognized strategic leadership coach who spent more than 25 years as a healthcare executive. He is also the author of four successful books, including Moppin' Floors to CEO.