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in 2009 there is no bigger issue

Dear Mr. President:

It is time to look at a reform plan that will really work, be bipartisan (a campaign promise, remember?), along with lowering costs and increasing the number covered and the quality of care (something lost currently in the political process).  Sound good so far? 

Here is the plan for reform:  3 years, first year focused on increasing competition, the second on moderating demand, and the third on completing projects to affect the supply side.   You can as a result answer most of the critics, reform the high approval of the process, and make Congress learn that it can do more than just create bureaucracies.   This is intended as a framework and one to vary as the opportunity to do more arises.   Having a several year plan will keep the risks of doing something wrong to a minimum, and keep the various interests and public fully informed and engaged at solving the problem, not rushing to gain a position in the que for attention.

First year:  increase first the competitiveness in the healthcare industry to encourage these markets to begin to operate as such.  

  • Allow first that individuals can buy insurance in any State, and that the HSA model is greatly expanded as an option for all, even those in Medicaid and Medicare.  
  • Review all mandates at the Fed and State level to rank them as far as restricting competition and set a sunset time period for each. 
  • Insure that individuals have the same tax benefits as employers/employees have.
  • Systematically remove the mandates that load cost onto hospitals and doctors. 
  • Begin to review all laws that restrict or hamper the effective practice of medicine as a business.  Do tort reform in a concerted manner, based on a rank order process with input from a variety of doctor inputs. 
  • Take a hard look at the uninsured and those that have pre-existing conditions, and challenge the insurance industry to propose means to solve, free of lobbying efforts.  Set aside a pool of tax dollars to assist in the effort, but aim primarily at cooperative efforts between hospitals, doctors and insurance companies working in conjunction with non-profits.
  • All of this being very visible to the public.
  • Remove the mandatory mandate for Medicare, allowing private citizens to use private insurance, while giving these individuals some credit for the taxes they paid into Medicare.
  • Draw upon retired business to mentor the executives in the healthcare industry, to improve their management technique and business acumen.  Delve into best practice, and make this widely known.

Second year:   make the demand side more intelligent and self regulating.

  • Convert Medicare and Medicaid to a HSA and voucher approach, putting the patient truly aware of costs, and making this apart of the decision process. 
  • Establish HSA accounts for these folks could be coupled with a high deductible and with increased financial liability for having life style related illnesses.  This requires some creativity and work.
  • Promote private enterprise to create EMR solutions that doctors and hospitals will use.  Engage with private companies to find out what are the barriers to this line of business.
  • Make costs readily available online, and best practice a credible information source also online.
  • Use a private healthcare coach model for chronic illness patients who consume a large amount of  services.
  • Expand HSA approaches wherever possible. 
  • Give visibility to innovation insurance  and means to deliver care.

Third year:  work even further on the supply side.

  • Review the care giver model and make sure that there are good solutions for the variety of common ailments.  In other words allow for more cost effective options for medical care, relying on online suggestions, skilled medical staff (read not all doctors), and online diagnostics, etc. to enhance the choices for patients.
  • Promote innovation in providing healthcare.  Minute Clinics and other innovations in insurance and use of technology.
  • Incentivize doctors and hospitals, even insurance companies to bring about the local community clinic model. 
  • Review and change the training of doctors, the number and the degree of specialization.