Friday, August 2, 2013

If I Were King

I think we all have fantasies from time-to-time of what we might do if we were made King for a day (only benevolent kings, of course—no despots need apply!)  What decrees might we issue to make the world a better place?   What changes would we order to make our politics better?  What improvements would we institute to make health care better?  Well, here’s my (health care) list:

1. I would decree that every American will have guaranteed access to health insurance coverage that can’t be taken away.  (In the context of the current state of American politics, I would give the people and their elected lawmakers a choice: work to ensure that Obamacare covers everyone as originally intended, or pass another program that would cover as many or more people.)  The one option I would not allow to continue is a system that denies access to tens of millions of people.

2. I would free physicians from the stranglehold of paperwork, rules, and mandates that do not improve patient care.  I would implement a single, paperless billing system for all payers.  I would order the makers of electronic health records to create ones that really make it easier for physicians to deliver better care, rather than imposing more burdens on them.  I would require that all existing and new rules and regulations meet two simple standards: are they absolutely needed to protect the public and improve care, and are they achieving this objective in the least burdensome way possible?  If not, get rid of them.

3. I would make medical education free for physicians who go into primary care and I would put them at the top of the physician pay scale.  I would remind the people that there is no one more valuable to patients and the health care system, than a well-trained primary care internist, family physician, or pediatrician.

4. I would order a ceasefire in the ongoing interprofessional battle between physicians and nurses, giving them 24 hours to reach an agreement on their respective roles and responsibilities in patient care, with the only requirement that the agreement must put the interests of patients first, not their own territorial interests.

5. I would decree that all hospitals, physicians, drug manufacturers and medical suppliers disclose their prices in advance, and I would require insurers to disclose how much of that price they will cover, in an Expedia-type format that would allow consumers (and their physicians in making referrals) to shop around for the best price. 

6. I would decree that patients also have access to understandable and accurate measures of the quality of care provided by the hospitals and physicians in their communities, and patients’ experience with the care they received, so that patients (and their physicians in making referrals) could shop around for the best quality and price (see #5 above).

7. I would direct government and health insurers to allow physicians to innovate in how medical care is organized and delivered, rather than imposing the flavor of the day (ACOs anyone?) on them, as long as they can show that the innovation improves outcomes and lowers cost.

8. I would impose common-sense controls to reduce firearm injuries and deaths, including universal background checks and a ban on high-capacity ammunition. 

9. I would repeal the Medicare SGR (enough said).

10. I would make our political system work again, by banning big money contributions (yeah, I know the Supreme Court said I can’t, but remember, I’m the King in my fantasy!), by making Senators really talk non-stop if they are going to declare a filibuster to impede legislation or appointments, by banning political gerrymandering of legislative districts, and by telling Congress that the art of governance requires compromise, and they have one week to produce a federal budget that reverses sequestration and ensures funding for essential health programs, that takes the debt ceiling off the table (once and for all), that ends the war over Obamacare, and that reforms entitlements and taxes.  And then, and only after they agreed to these conditions, would I resign my position on the throne and turn power back to them.

Okay, back to reality.  I know that in the real world no one is going to make me King.  Yeah, I know in my heart that democracy, for all of its flaws, is a better system than benign dictatorship.  I know all of the reasons why most of my fantasy wish list is considered to be unrealistic in the real world of public policy and politics. 

But yet, is my wish list really too much to expect from elected lawmakers in Washington who take a solemn oath to a Constitution that requires them to promote the common welfare and ensure domestic tranquility?  Is it too much to ask that we provide every American with health insurance, that we free doctors from unnecessary red tape and paperwork, that we enact policies that support the value of primary care,  that physicians and nurses put aside their differences so that they can work together to provide the best possible care to patients, that we facilitate choice and completion by posting comparative information on price and quality, that we keep guns out of the hands of insane people and convicted felons and that we limit access to guns that allow murderers to kill as many people as possible in as little time as possible (including schoolchildren), that we repeal the ridiculous SGR formula, and that we reform our politics so government can actually start governing again?  Is that really too much of a fantasy to ask of the people we elect?

Today’s questions: If you were King, what changes would you make in our health care system and politics?  What do you think of my list?

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