Guest opinion: Eleven steps to real health-care reform
August 22, 2017
Editor's note: This was originally sent as a letter to U.S. Sen. Michael Bennet, D-Colorado.
I appreciate the opportunity to share my views on what it will take to change the outlook on health care in this country. It is my belief that a fundamental change in approach to health needs to occur if we are to truly change the trajectory of costs of medicine in this country.
We are excellent in providing rescue medicine to our population, which without question is one of the self-induced sickest on Earth. A population attentive to preventative services and cultural changes conducive to health will decrease utilization and the need to rescue. We need to change our behaviors to eat better, exercise more, and avoid cigarettes and alcohol.
If I were placed in charge of health-care reform I would do the following:
1. Increase the tax on cigarettes by $1-2 a pack and put the revenue back into Medicaid and Medicare. Smoking has cost this country billions upon billions of dollars in health-care utilization, and the culprit should be held accountable.
2. Teach cardiovascular exercise in the schools again. Schools no longer teach physical education, and the reality is habits are learned at the school age. Please look into the program in Naperville, Illinois, which incorporates rigorous exercise into the daily curriculum. Kids there actually have some of the highest academic scores in the country. Overall, kids are sedentary, and this follows them the rest of their life.
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3. I think sin taxes can be good to induce a cultural shift on health. Tax alcohol and high-calorie fast food and put into the Medicare and Medicaid program.
4. Re-evaluate federal funding for medical residencies. We need more primary care physicians. Good data exists that show communities with a good ratio of primary care to specialists helps control health care costs. Funding primary care residencies at a disproportionate rate as well as perhaps lower interest rate student loans to primary care doctors may funnel more medical students into these careers.
5. Re-evaluate the copay for Medicaid patients. Copays bring accountability and decision-making into the equation and as commercial insurances do this, I think the federal government should follow suit. Emergency visits traditionally have a higher copay as the expense goes up, but this not the case in the current set-up. A prescription copay should be considered as well.
6. The SNAP (food stamp) program should remove unhealthy foods from the list of items available for purchase. Red Bull and Twinkies should not be paid for by the taxpayer when the taxpayer is also responsible for paying for the health insurance of those individuals and the subsequent high utilization of the health-care system from poor eating habits. Encourage needs versus wants.
7. We should raise the Medicare tax on the wealthiest Americans. We need to fix this on both ends of the financial spectrum. It is my opinion that most folks would be willing to pay more if government waste is addressed.
8. Health-care saving accounts are a great idea.
9. We should re-evaluate different farm subsidies and view them from a healthy eating standpoint. Corn is overproduced and in everything we eat. Subsidize healthy foods.
10. Increase transparency of costs. Consumerism can have a role in reducing costs. Patients should be able to easily shop for the best health care deal like anything else, especially if they have a higher deductible insurance plan.
11. Re-evaluate reimbursement for different procedures. Supply and demand should set costs in the health-care market as it does in others.
Dr. Kevin Coleman is chief medical officer for the Grand River Hospital District based in Rifle.