As a practicing physician, I see the fallout from our current healthcare system daily. I have seen our system from both sides as a provider, patient, and patient advocate. This system is not just failing; it is on the verge of a catastrophic collapse. Much as our country has seen a degradation of infrastructure over the last several decades.  We have also built up a huge health deficit, which means that given access, there will be a large upfront financial impact on any meaningful reform.

Two key factors to keep in mind going forward are that we currently have universal coverage, but neither effective, nor efficient coverage. Secondly, the bureaucratic, non-health related overhead is skimming an excessive amount of healthcare dollars from a faltering system.

If we accept the fact that we are already paying for universal coverage, then perhaps we can devise a more direct, upfront funding approach so we can attempt to gain control of costs. The most effective way to do this is via a tax based, centralized system. That does not mean government controlled health care nor government employed physicians, but only an equitable approach to funding healthcare that assures universal coverage.

The insurance industry does not have to be eliminated as they do provide a structure for control and disbursement, but they need to be taken out of the industry of only insuring healthy individuals, and they need to be held accountable to some to be determined minimum standard.  In addition, we need to simplify and standardize billing, preferably with a single central billing clearinghouse.

Another key issue with healthcare reform is guaranteeing access. It does no good to provide Medicare coverage to people, if no physicians are seeing Medicare patients. Yet I see this happen all too frequently even now. In the past, physicians have seen Medicaid, Medicare, indigent patients out of a sense of personal responsibility more than because of financial incentives, but as reimbursements have continued to tighten, it becomes less and less viable to do this. Now, with increasing penalties for "fraud" and increasingly draconian recovery plans, it is increasingly too risky to provide this care.

The key to reform must be universal accessible coverage, with an emphasis on preventive healthcare as well as aggressive disease management, while cutting costs by improving quality of care, and cutting unnecessary overhead. Competition needs to be encouraged where it can be, and people must understand the costs of the care they are receiving so they can be educated consumers and make healthy and financially sound choices.

Brian Smith, MD – Rapid City, SD

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