Health Reform- a few further thoughts

UPDATE:The article here offers an interesting comparison between the French and British health care systems. Almost a controlled trial since the writer had one hip done in the NHS and the other in France. That article link is no longer valid but this one is interesting. Sound familiar ?

In recommending Medicare as the vehicle for the basic coverage in a national health plan modeled on the French system, I did not intend to suggest that Medicare, as that vehicle, would be a government agency. I was recommending a non-profit corporation funded by payroll or other contributions from beneficiaries. Medicare, in theory, is funded by the Medicare tax contributions of workers prior to retirement. A system for active workers would be called the same name and the two programs, plus Medicaid, would be rolled into one system. It would be funded, however, not by general tax receipts but by the assessment for health care, analogous to the French funds, the largest of which, CNAMTS, is for salaried workers. There are many other funds for other workers such as agricultural or managerial workers.

As far as the name is concerned, Medicare was the name for the health care program for military dependents when I was in the Air Force. The name was adopted for the retirement health plan in 1965 and the military then called its program “CHAMPUS,” and now calls it “Tricare.” The name is secondary.

My point is that this should be a non-profit corporation or foundation, sort of like CalPERS, the California pension program for government employees. Beneficiaries, employers, unions and providers should all serve on the board of directors. The retirement program, which is mostly funded by tax receipts now, can be represented by bureaucrats. Working people should be represented by their own members, elected or appointed, depending on the format chosen by members. This may be a very important part of the French system.

We have learned a lot about managing health care in the past 25 years. When I was in graduate school ten years ago, there were students in the same program from all over the world. This is a universal problem. I have consulted for the NHS when they adopted the “Fund Holding” reforms of Margaret Thatcher. The Labour government, once it took over from the Conservatives after Mrs Thatcher was no longer Prime Minister, made many disparaging remarks about Fund Holding, a reform with some similarities to American HMOs. However, they have kept most of the reforms in place.

In considering reforms, most critics of the US system look to Canada for ideas. This is because they are close to us and share our language and many of our institutions. They are not, however, a good model. I believe many mistakes were made and too much coercion was used in dealing with providers, a feature of our current treatment of doctors in the US. Because of language, few know much about the French health care system but those of us who have been working in health care, especially in surgery, are aware of the very high quality of care and innovation. We should also become aware of the similarities and of the very high level of satisfaction, both by patients and doctors.

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One Response to “Health Reform- a few further thoughts”

  1. […] except that heĀ believes that the US does need to adopt some sort of universal health.Ā  But he prefers a different model. In considering reforms, most critics of the US system look to Canada for ideas. This is because […]