Issues: Healthcare
The state of the nation's health is in crisis today. Almost 48 million people have no health insurance at all, or are underinsured in cases of serious health problems. As many as 9 million children have no health insurance at a time when the Bush administration is making efforts to reduce even further the number of children covered by government health care programs. The wealthiest nation in the world cannot afford to let people continue to die on a daily basis as a result of failures of our health care system. Every person in the nation deserves preventive and maintenance health care in a facility near their home. This care must be provided at an affordable cost, so that people are not forced to choose between food and medicine.
Universal Medicare System
Some form of national health care policy should be developed. Expanding a program similar to Medicare to include all Americans may be the best way to do this. Recent studies published in the New England Journal of Medicine document the cost savings to the system when people are allowed access to preventive health care before becoming eligible for Medicare. Those who were uninsured for many years enter the Medicare program with more overall problems and with chronic illnesses as a result of untreated disease. If all people in the nation had access to adequate healthcare, the nation would benefit in the long term from lower numbers of work days lost and increased earnings from wage earners who can live and work for a longer time.
Preventive Care
Prevention is worth a great deal of cure in medicine. Preventive programs encourage healthy eating, exercise, and smoking cessation. Vaccination of young children is a good example of how preventive medicine accomplished the near extinction of smallpox, polio and other devastating diseases.
Community-based health clinics staffed by physicians and nurses should be made available to treat minor ailments, to offer preventive care, and to refer those patients needing more care to hospitals or other appropriate facilities. Some hospitals or medical centers should be specialized, to offer the highest levels of specific condition care available today. All hospital facilities, however, must be capable of managing emergency patients, if necessary.
School-based healthcare programs should be presented by local health care professionals, supported by school staff, or may be arranged on the internet for individual student use. Community-based facilities should have personnel available for school education programs, as well as home visitation to insure the following of instructions and healthcare check-ups for those unable to travel to a clinic. In addition, community-based facilities should offer evening and weekend programs for preventive health care, including smoking cessation and weight loss.
Workplace programs for preventive care may be put in place by employers in an effort to increase workplace productivity or may be brought to the workplace by staff from community-based healthcare facilities. All manner of preventive advice and suggestions should be made available, both on websites and in printed materials.
Electronic Medical Records
Advances in telemedicine must be put to the fullest use, especially in remote communities. To this end, medical records, X-rays, MRI images, and CT-scans should digitized.
Sex Education
Programs that allow teen education about the risks of sexually transmitted disease and about pregnancy prevention must be put in place throughout the nation. Abstinence-only programs have proved a failure, so contraception must be made available for sexually active teens. At the same, time efforts to keep sexual activity to a minimum are necessary. Education may be the single most essential factor. An educated teen armed with the full knowledge of reproduction and all of its ramifications is less likely to suffer the consequences of a teen pregnancy or teen fatherhood.
Paying for National Healthcare
Today, Americans spend about twice the amount per person as other developed nations spend on health care. That expense garners us only 37th place in world rankings of health care. We must find a better way. Government-sponsored national health care is inevitable if we are to save the health of our nation. A national health care program can be supported through a variety of means. Savings in overall costs by centralized care and mandatory negotiations for lowest drug prices will allow quality care at lowered costs. Contributions from worker insurance programs such as workmen's compensation will also make a difference. Private contributions to individual facilities or to the general system may be solicited and accepted.
Additional revenues may be generated from the patients themselves. All patients should be expected to pay for care in accordance with their means. Families with incomes smaller than 250% of the prevailing poverty level deserve free care within the system. Those with greater incomes may pay out of pocket or purchase private insurance in a manner similar to our system today.
More savings may accrue through the consolidation of diagnostic and care equipment in tertiary care centers, which are specialty facilities with the highest level of technology. My plan would reduce the number of tertiary care institutions while providing increased access overall by concentrating the equipment and staff in fewer facilities. Any patient needing advanced diagnostic or care technology would be referred to the appropriate place for care. Patients could then return to hospitals or other facilities closer to home when the advanced care is no longer needed.
Personnel Reimbursement and Training
Tuition reimbursement programs for undergraduate and professional education must be put in place for physicians, nurses, and other medical professionals to insure an adequate supply of such personnel. For those students working in under-served regions of the country, the reimbursement could rise to the level of all tuition-related costs. Those in better-served areas may get less or even nothing if an area is fully staffed. In addition, reimbursement for ongoing continuing education and additional advanced training is imperative.
Students at all levels of undergraduate education need an introduction to careers in health care. This introduction may come from the same community centers that offer local care and may include actual experience in such a facility. The more exposure students have to the healthcare professions, the more likely they are to pursue one of those careers.
Personnel may be paid with a combination of salary and incentives. Physicians and nurses wishing to work specified hours and doing specified jobs may be given a salary commensurate with their responsibility. Additional incentive pay may come as the result of increased patient success or care or from increased numbers of procedures accomplished. In all instances, the primary factor must be quality patient care at all levels.
