Fixing health care Overview
A normal working family of four in New Jersey spends $8000.00 a year paying for health care insurance. That family would be ahead if the government can do it for $6000.00 a year (actually, Medicare is that efficient already).
When considering the problem, consider what you are presently spending for your insurance and compare it with what you will be spending for insurance plus any increase in tax.
Computer technology gives us the ability to store knowledge and experience. It can be used to replace the art form of healthcare with a superior alternative. Compassionate technicians armed with a computer will be able to outperform our present brightest and best doctors.
Our armed forces (after they get out of these unholy wars) will be dually educated in warfare and health care. Giving an idle army productive work makes our nation more secure by giving us a larger reserve army while reeking the benefits of their productivity.
How can we get from here to there? Medicare as a processor is already extremely more efficient than any competing HMO. Medicare, Medicaid, state and county nursing homes, VA hospitals, the Veterans Administration and the office on aging will be restructured to limit duplication and bring the efficiency of Medicare to the new and unified bureaucracy. The private sector of health care will still exist for those who wish to use it.
Some patent medicine reform is necessary.Computer technology
The individual health card
Every client of the Federal Healthcare Service will have a computer card with their complete health record on it. In addition to your complete medical history it includes your ambient readings, that is your normal blood pressure, heart rate, weight, complexion and on and on.
The medical diagnostic mainframe computer
This is predominately a body of symptoms set against probability distributions of causes with a parameter adjustment for what is normal. It has branches to suggest tests to proceed toward a better diagnosis.
The computer file is constantly updated with medical knowledge from the field as well as from a body of experts. For example it would contain all the viruses known to man. It would contain who was diagnosed with what and when in world demographic form.
It would branch to suggested treatments based on adjustable statistical reason.
For example, the computer is almost certain the person has a cold or non-fatal flu. It says take acetaminophen, drink water and go home. It does not bother to determine whether it is treating a cold or flu because it considers test cost. It might however request a test because it is tracing the spread of flu. It needs the results for its demographics.
We have the technology and can afford to build this computer. An individual health card is inserted along with new patient data that may contain the patient’s complaints. It compares the new data with the individual ambient and its files and reacts accordingly.The human physiology mainframe computer
Rather than responding to the test results performed on a human being, this computer responds to the requests of health professionals.
This computer is used during surgery and to monitor patients in the hospital. It is the expert in physiology. When used during surgery or any other invasive procedure it is the ultimate medical brain focusing on one body during one procedure. It has a record of procedures complete with pictures, some normal some abnormal. It both directs the surgeon and assists him. It tells him what to cut and shows him a picture. It directs the anesthetist.
Because it is connected to the medical diagnostic mainframe computer in a fast response mode abnormalities in bodily functions comeback like “ Telstar” directions. In the ultimate technical surgery drugs would almost automatically be administered. Eventually the anesthetist would be considered more dangerous than computer control.
Of course if an aide wanted to properly insert an enema she could ask the computer to see a picture. It’s just part of normal human physiology.
As a surgical training tool it could duplicate the visuals of a surgery without reference to a specific human being. The difference between the surgeon doing microsurgery through three holes in the body using a screen would be no different whether there is a body there or not.The health professional
When you have a physical examination you still need a person to take your blood pressure, draw blood, and do all the pokey things. They will have to know how to put it onto your individual health card.
When you seek medical help you will still need to say where it hurts, how bad it hurts and when it hurts. It will still be a medical art form to judge and input to a computer the parameters of the hurt.
When you have surgery someone will still have to hold the scalpel. When you’re too old to feed yourself someone will still have to feed you. Nursing home or hospital, you may need help getting to the bathroom. Above all handholding will be as important as ever.
The cost of paying people to be smart and the errors of smart people (the expectation that smart people don’t get tired) are what has made medical care so outrageously expensive. You will not need a health professional who knows everything anymore. That’s what computers are for.The armed forces
as the Federal Healthcare ServiceEvery soldier gets one month of military training, one month of furlough and ten months of (health) service every year. As an aside I would note that they would be ideally trained for national disasters. For ten months a year each soldier would man the federal health care service. This would give us a substantial re strike force and an efficient use of this force when we are not at war, a state most of us wish to maintain.
Consider a 20-year military career. You might start as a private in a hospital cafeteria. The desire for self-improvement leads you to becoming an aide where you develop some compassion. You become a corporal spending some time studying for the LPN test (or some other specialty). Throughout this experience you are always using a computer so that knowledge is as close as a keyboard but the skill of dealing with patients is still learned through hands-on experience. There is no need to go fast. You might become a LPN in one year or five years.
You might become a sergeant RN. From there you may choose to pursue a lieutenant nurse practitioner, or lieutenant surgeon. After that you may become a captain doctor of internal medicine. If you make this rank you will be obliged to finish your 20 years. On the other hand it might take the whole 20 years to get there. When you get out you will be educated in the healthcare field with no loans to pay off.
I would point out that being a doctor will be easier because no one will have forced you to spend 20 hour days and all of your intellect for a period of years to become one. Intellectual giant would no longer be a pre requisite. Compassionate person would be the pre requisite. However, it is most probable you would not be able to be an effective doctor without the use of the computer.
I would also point out that we would not need many doctors as they exist today. Most would be replaced by computer literate health workers. The private sector would still have doctors for those who wish to pay the premiums.
You will be learning to always work with the computer for knowledge, always using it to double check your decisions. You are a computer literate health worker. Because you are computer literate you are always up to date.The Federal Healthcare facility
This will include the existent VA hospitals, private hospitals that want to go public, assisted living facilities and federal and state nursing homes. They will be manned by a combination of private employees and the Federal Healthcare Service except in times of war. In times of war the Federal Healthcare Service will need to use additional contracted private personnel.
In addition to the boundaries of present health care, catastrophic illness will also be included. In laymen’s terms this means the Federal Healthcare Service will run nursing homes.
All integrated federal health care facilities will include a computer integrated schooling system. It will educate all phases of healthcare workers. It will not however be fast track education as is the case with healthcare worker education today. It will be acceptable to complete three years of medical school in ten years while serving as a nurse practitioner. You will not be allowed to be a doctor until you have been a LPN or specialist, a RN, and a nurse practitioner. During all of your schooling you will also be serving. It will be possible to begin your enlistment at a higher level if you already have that training. This will give a RN an affordable path to becoming a doctor.
I would point out that the need for doctors would be greatly diminished in favor of RN’s using computers, surgical technicians using computers and computer controlled anesthesia.The finances
who pays and who getsPresently HMOs compete with standard insurance companies. Medicare outperforms both. The union of HMOs with Medicare is our most efficient present supplier.
All three are financing agencies. All three are dependent on expensive suppliers. With the Federal Healthcare Service we would have a lower priced supplier.
Private medicine will still be able to compete. Remember that the Federal Healthcare Service cost includes medical schooling of a standing reserve army as an extra. It also includes paying the reserve army when they are in Health Service.
I am sure the Federal Healthcare Service will not be the only one using computers as soon as HMOs see how cost effective they are. In addition catastrophic healthcare premiums will be reduced as soon as private sector nursing homes must compete with Federal Healthcare Service nursing homes. When the private sector becomes price competitive the public and private sectors will keep each other honest through competition.
Medicare would be both the arm of the Federal Healthcare Service and serve as it does now for our seniors. The choices that exist today would still exist. There would be an additional choice. You could select Federal Healthcare Service.
The price for Federal Healthcare Service for those between 18 and 65 would be based on cost. Under this selection, you would use the Federal Healthcare Service and its personnel exclusively. Medicare would be the policing agency like it now is for seniors.
Federal Healthcare Service would have a yearly minimum and a co-pay. With this service you would not be allowed to have a second insurance company (except for drugs administered outside of hospitals or nursing homes). By making it necessary to spend some of your own money for any medical service will overcome the flaw we now have. Namely, we do not pay individual attention to our medical costs.
Minimums and co-pays of Medicaid recipients will be paid. However the only acceptable Medicaid selection will be the lowest priced system.
If you are eligible for Medicare you can select Federal Healthcare Service at the same price as Medicare Part B. You will still not be allowed to buy a supplement. However the policy will come with a maximum monthly medical expense not to exceed 30% of social security income.
If you select the Federal Healthcare Service before age 68, it will include catastrophic care with a maximum monthly nursing home expense not to exceed 90% of total income including social security with the following exception. After 30 days of continuous life support the maximum exclusion does not apply.
No more than 30 days of continuous life support will be paid for by Federal Healthcare Service.
Federal Healthcare Service will be free from age one through age eighteen. It will be paid for by eliminating the income tax child credit.Patent medicine reform
Patent law began as an exclusive right that lasted seven years. Then it was corrupted time and time again. You can patent some things for 56 years.
For lifesaving drugs give drug company’s seven years and no longer. If it’s a matter of saving lives, charities and possibly the government may have to pay the greedy bill. But that’s for seven years only.
After seven years, if it is judged a lifesaving drug, then any drug company can copy and not pay a royalty.
For this we will protect our borders from the drug smugglers who would smuggle Canadian drugs into the country.
An exception; if a drug company has done all its research without receiving $1.00 of government aid for any drug research ever, then give them fourteen years.
The bargain struck may not be this one. The important point is that we must negotiate a change in patent (medicine) law rather than restructuring the collecting of money to give to drug companies.How to get from here to there
federal legislationI am assuming that my income tax legislation is already in place. Now Medicare money is from the general money.
Patent reform for medicine and medical software is the first step. Those companies that develop the medical software must be limited to a seven-year bonanza. After that medical software must be public domain. Since this software will need updating an agreeable patent bargain must be set for the pricing of updates. An acceptable alternative (and a bargaining chip) would be that the updates come from a Federal Healthcare Service brain trust.
The government will subsidize the development of the individual health card, the medical diagnostic mainframe computer and the human physiology mainframe commuter.
VA hospitals will be converted to teaching hospitals. The dual role of the Army will be established to supply these hospitals with student personnel.
Nursing home and hospital buyouts will be pursued on a one by one basis by the Federal Healthcare Service at a rate to keep up with the expanding enlistments. New government facilities will only be built when there is a need for more facilities or to prove the government’s willingness as a means to establish better bargains.
Federal healthcare Service will be offered for free to people between one and eighteen years old. Next it will be offered as a choice at the price of Medicare to seniors. Finally, when the system is big enough it will be offered to all US citizens at cost.
When we get back to living in peace we are going to have an army that does nothing but is necessary for that moment we need it.