Smiling confident doctor shaking hands to the female patient in the office, she is holding medical records

EDITOR’S NOTE: This opinion piece is the fifth submission from a group of citizen authors of diverse ideologies who meet regularly for civil discourse on public issues and seek agreement on public policy issues. This is the final article of a three-part series focused on health care in America.

This health care plan is a multi-faceted program that weaves together personal responsibility, government, school and workplace involvement, cost monitoring and reductions in all areas of health care and, ultimately, an integrated plan to ensure quality care for all citizens.

• Basic health care coverage should be all inclusive.

Every American citizen must be included to make a universal system work financially and to enhance the health of everyone while reducing the overall cost of health care, which currently accounts for an estimated 18% of Gross Domestic Product (GDP). 

This includes meeting essential health care needs (as with Medicare) as well as fully ensuring catastrophic coverage to prevent bankruptcy (medical debt is the number one cause of bankruptcy in America). Supplemental plans should be available for those wanting expanded coverage. 

A critical point is to do no harm to those who currently have health insurance. There should be minimal negative impact on current levels of coverage and affordability. This universal plan would be funded via individual taxes similar to Medicare, retention of employer/employee tax payments and government subsidizing for those unable to financially contribute. The funds would be sequestered and could not be used for any other purpose.

• Implementation should be incremental. Implement incrementally a universal health care plan within a defined period for all citizens. Everyone will be guaranteed the same reasonable level of care needed to thrive.

Persons now relying in whole or in part on Medicaid and CHIPS, will move into this new program and, until a single-payer universal plan is fully implemented, a combination of employer-funded and government supported insurance exchanges will be utilized. 

Within a reasonable timeframe, all citizens should be in the universal plan. It is recognized that it will likely be necessary to increase taxes for Medicare to cover the increased costs. All insurance will be transportable regardless of origin.

• Costs and preventive actions must be a shared responsibility between society and the individual. Whether initially in the universal program or not, every able-bodied and mentally competent adult will contribute financially or in some other manner. For those unemployed or unable to financially contribute, other in-kind contributions may be used such as community service.

Employers could fund employee insurance until the universal plan covers everyone and then fund a supplemental insurance program as desired. 

• Strengthen state and national public health care programs. All aspects of the health care system should be collaborative and include medical, exercise, nutrition, education, workplace, media and a host of other influencers and providers to focus on prevention via knowledge and maintenance of healthy habits.

This system must rely on incentives rather than penalties wherever possible to encourage everyone to commit to making healthy choices. Preventive care must be integrated into people’s lives with special emphasis on the young.

Much more can be done in schools and the workplace to promote health. 

The media is a major influencer and should be incentivized to do public service announcements on healthy habits.

It will be necessary to significantly increase public and private funding to meet the expanded public health services and programs.  There must be strong national leadership to coordinate the multiple efforts among national, state, and local government and all health entities.

• Reduce health care costs and increase efficiency. Plan should allow for reasonable profitability, avoid disincentives for medical innovators and service providers and provide standards of cost based on agreed upon criteria.

Non-government entities should be the primary producers of health care products and service delivery. Government’s role is to set standards, share information about health care with providers and consumers, and coordinate regional and national health care infrastructure and processes. 

We need to open states to all insurance carriers with no geographic restrictions to encourage competition and provide citizens with a wider range of options. The federal government should leverage its purchasing power wherever possible to obtain the best prices for drugs and medical products and services.   

The pandemic made more apparent the cost savings and effectiveness of health services delivered via use of telemedicine. A major health care cost is paperwork. Accelerating digitization of all administrative processing, imaging, medical records, and other personal information will provide major efficiency gains. Introducing artificial intelligence-based diagnoses and drawing upon large data sources to analyze diagnostic information will provide physicians with treatment recommendations, reduce error rates, reduce time per patient, improve outcomes and reduce costs.  Rewards for cost-saving innovations and reporting waste, fraud and abuse in health care must be part of the plan.   

There should be a citizens’ review board to oversee government management of the system in terms of managing the funds, reviewing service costs, determining benchmarks and other components of this program. 

• Health care outcomes should be measured and improved. It is important to track service delivery, quality of care and improvement in health care outcomes. It is essential for the government to monitor the effectiveness of specific treatments and outcomes for all services. 

This plan can be affordable and cost effective when implemented in stages. This will be a better health care plan because everyone will be included, it will cost less, and it will be a cohesive and coherent program. It offers better health care compared to our current patchwork health care system and does so at a cost that will be at or below the 18% of GDP we spend annually. 

The dialogue group is interested in growing to help increase its credibility and impact. If you have an open mind, are willing to learn regardless of your political views or party, and would like to join or learn more about our group, contact Richard Hammes at rhammes@comcast.net.

Authors: Roger Bernier lives in Okatie; Greg Blackburn, Bladen Crockett and Earle Everett live in Bluffton; Rick Dean, Richard Hammes and Emily Oetjen live on Hilton Head Island.