Article 98. Transition to a New Government Catastrophic Health Care System

Transition to a New Government Catastrophic Health Care System
By Lawrence Rosier Consultant
Based on the suggestions in Article 97 and the implementation of VA reforms in Article 96.

My approach is to let the people pay what they can afford and above that have the government provide catastrophic heath care to all Americans.  This is what most Americans want.  Health care recipients should pay each year for their own health care from private providers up to a specified near catastrophic amount determined by income at several levels.  Paying all the health care costs for everything that people want is not possible and should not be provided by the Government. For example abortion should not be paid for as a part of health care.

As an option private Health Insurance Companies can compete in providing the minimum coverage up to the catastrophic level if wanted by individuals and companies. Insurance coverage for Catastrophic Health Care has been proven to have failed under Obamacare and does not work.

The Federal Government should not provide healthcare to non-citizens, however State Governments may chose to provide this service.

The key to this system is the elimination of Private Health Insurance and Private Hospitals from the Catastrophic Health Care System. Health Insurance for catastrophic health does not work because profits necessarily drive up insurance rates and co-pays.  Private Hospitals have resorted to massive fraud to survive. Congress has not been able to prevent the waste and corruption found in our health care system. Americans simply can not afford or be expected to pay for a health care system that is the most wasteful and expensive in the world.  The current health care waste from fraud and abuse has been passed on to the public and not enough has been done to make the day to day health care processes themselves efficient.  But now we have the Reforms to be implemented in the VA which makes health care efficient and effective. This makes possible the Government Catastrophic Health Care system as an affordable alternative to the current fraud based Private Health Care system and over priced Health Insurance system.

Transition Alternatives:
The VA Healthcare system must have reforms fully implemented in all of its facilities and be treated as a separate system providing Vets the health care they need.  The VA system changes according to needs of the Vets with age and with injury types.  Therefore there is a need to go outside the system for healthcare it cannot provide.  This alternative could be the Catastrophic Health Care System that mostly serves those receiving Medicaid.  The cost of the Catastrophic Health Care System may be shared with the State Government.

In the future the US Government may pursue the development of a complete government Health Care system for Medicare as an alternative to the current private health care delivery system that is mainly driven by fraud. Without this approach Medicare will become less and less affordable causing the starting age to be raised and benefits to be cut.

We must separate and remove all healthcare costs that have nothing to do with healthcare.
All drugs, supplies and equipment must be purchased on the world wide market.  This means for example that a drug manufacturer can not sell a pill in the US for $100 and in India for $2.  All drug sales must share in the development costs and the drug will have a single world wide price.


Example of Why the Cost of Health Care can be Reduced 
The CBS 60 minute segment "Out of Darkness" by two eye surgeons Sanduk and Geoffrey Tabin who relate their activities performing cataract surgery in Burma where 100 or more patients were operated on each day compared with 5 in the US.  This is an actual patient increase in efficiency of 2000% and a reduction of cost $2000 in US to $20 in Burma per patient eye.

In the future government run Cataract Surgery hospital units can be established in major cities.  As many as 50 eye surgeries can be performed per day reducing the cost per eye from $2000 to $200.  These hospitals can serve Veterans as well as Medicaid and Medicare patients. This will bring down the cost of cataract surgery by a factor of 10X.

The surgery was accomplished by introducing efficiency and the elimination of Red Tape.  Given this example there is no reason that a goal of 50% reduction in health care costs can be attained over time in the US.  This can be attained and tested through the implementation of Enterprise Lean In VA hospitals where 90% of employees meet once a week to make continuous improvement in their processes. With the reform of Continuous Improvement ALL Health Care Costs can be reduced by as much as 50% over time.

If you are one of those who are offended by the assembly line operations in Burma then you should consider the blind patients who walked miles to get to the Clinic for the 5 minute operation that restored their sight. It is possible to have an assembly line of operations and still preserve the dignity of the patient.  This is the price of having efficient health care, the alternative is no universal heath care.

It is important that congress can see what actually can be done.  Continuous improvement suggests that the number of patients processed can be increased in stages from 5 to 15 and then up to 40 patients per day in the US. The Teams biggest challenge will be in getting rid of red tape.

Example of how Cataract Surgery can be Implemented in the US
Cataract Surgery Clinics can be established in every major city of over 100 thousand population.  Each surgeon can perform surgery up to 40 patients per day with minimum expense of about $400 per eye rather than the current $2000 cost.  The Eye clinics would serve Veterans, Medicaid and Medicare patients saving $billions.

Supporting Article
New Yorker's 2012 Cheesecake Factory Article missed-Enterprise Lean, Continuous Improvement as the solution to obtaining improvements to health care that the author was looking for. http://www.newyorker.com/magazine/2012/08/13/big-med …
 
 Advantages of the Catastrophic Health Care System
People without serious health problems will not be required to buy healthcare through a Health Insurance Co. But they must pay for their health care with what they can afford based on income with the remainder covered under the Governments Catastrophic Health Care System.  Families will not be devastated with high healthcare costs forcing them to sell their homes.

Doctors incomes will not be curtailed they can still specialize in diseases of the rich outside the government heath care system.

This approach is supported by Dr ken Davis Mount Sinai Hospital: "Conservatives have got to deal with reforms that affect Health Care costs, House & Senate Health Care bills don’t." PBSNewsHour Monday June 26, 2017

Rural Health Care Solutions
Cataract surgeries may be done by a traveling team of eye surgeons and nurses visiting designated rural Clinics on a periodic basis.  They can perform up to 20 surgeries in a two day visit to a clinic.

A traveling dialysis equipped van can visit rural clinics on a regular basis where patients cannot get to a dialysis equipped hospital.