Our health care system isn’t really a system at all. Let’s try again to reform it

SYSTEM: a set of principles or procedures according to which something is done; an organized scheme or method.

The purpose of a health care system is to provide health care to those who need it. Patients need to know they can access that system when they are sick. All of us, sick or healthy, working or laid off, young or old, need to support the system financially and follow the rules.

An organized health care system should arrange for needed supplies, workers, facilities, financing, and administration. It should assure that resources are available when and where they are needed. Nurses, doctors, and specially trained staff will need to be recruited and trained years in advance.

The system should explicitly define expectations and establish procedures to provide for all aspects of health care.

Health care system design is a very contentious topic. It generates a lot of heat, but little light. There are too many competing assumptions and opinions — no guiding principle. No course is the right course if you don’t know where you want to go.

So where are we now? The U.S. has at least six kinds of subsystems going:

1. Socialized medicine: The military and the VA;
2. National single payer (Medicare, limited to those over 65);
3. Government financed with private providers: Medicaid (for low income) and CHIP (for children and youth);
4. Government regulated and subsidized private insurance: ObamaCare, Tricare;
5. Private/employer financed commercial insurance and individual policies;
6. Charity care (hospitals and volunteer clinics).

These arbitrary distinctions create a bewildering patchwork of insurance companies and regulations that vary from state to state and create a mind-numbing array of competing plans, restrictions and provider networks.

I worked in a number of systems including a free volunteer clinic. My strong preference was for a system that considered first the needs of its patients and its providers, eliminating profits and conflict of interest.

The subsystems we use today compete fiercely for income and resources, even in the publicly administered systems. Why rely on employers to provide health insurance that vanishes if employees get sick and lose their jobs? Is it a good idea to have doctors referring patients to labs and other services they themselves own? Why is it OK for an insurance company to use premium dollars for profits, unnecessary paperwork and arbitrary denials instead of for care?

Our present health care “system” fails to meet the medical needs of our patients. Tens of millions are uninsured or underinsured; they have no medical security. Consider also the heartbreak of medical bankruptcy and the non-monetary cost of illness: personal suffering and opportunities lost.

The money spent for claim denials, salaries, profits and marketing in the private insurance subsystem amounts to 20% of their revenue. Why not send our health care dollars to an accountable public organization with one eighth the overhead? Why must we send our health care dollars to middlemen?

We must demand answers to all these questions.

A good overview can be found in an October New York Times opinion piece by J.B. Silvers. Another detailed source is from Physicians for a National Health Plan.

Leading the transition to an efficient patient-centered system will not be for the faint of heart. Some day we will elect leaders with the determination, strength and authority to implement a real health care delivery system — one that serves all of us.

Frank Turner is a retired physician and supporter of health care reform during and after the Affordable Care Act debate. He can be reached at ft113203@gmail.com