If we are to go to a Universal Health Insurance plan such as UNIMED, much of what is currently in Medicare can simply be directly transitioned.  There are however known loopholes and excesses that must be corrected if we are to achieve a government sponsored universal medical insurance plan with both logic and compassion.  Some of the following items could provide significant cost savings for the tax payers, and vastly improve the health insurance system in the USA.
 

Generic-only Prescription Drugs Unimed should not cover prescription drugs as Medicare does at present.  Prescription drugs are 100% replaceable with their generic equivalents, except in those rare cases where a brand name drug has recently been introduced and there is no generic equivalent available until the drug's patent expires.  If these new drugs do in fact provide a cure, an exception to the Unimed apothecary should be provided.  If an individual desires to have prescription drug coverage, he/she can purchase a private Unimed Plus plan that provides it.

Activity Networks Much of the malpractice tort cases that go to court today arise from medical "mistakes" that are made in the health care system.  These errors in medical procedure are usually due to some small detail that was overlooked, perhaps a test that was not performed, a mistake in the drugs prescribed.  Once a diagnosis is made by the attending physician, the medical activities that must be performed on each patient should follow the AMA "best practices" activity plan, not the guidelines defined on the volumes of procedure manuals in each hospital.

Activity networks allow multiple health providers to work on a "checklist" basis, using hand held PDA's, that follow each patient's  treatment plan, step by step, following a structure visually similar to a PERT chart.  Activity networks are multi-threaded task sequences that are assigned to different health providers, laboratories and pharmacies, each with an electronic completion verification that would in turn enable further actions by other health providers down the plan time line.

The Unimed system would not allow medical negligence cases to proceed unless it can legally be shown that the activity plan was not followed in detail for the diagnosis agreed to by the attending physicians.  No physician should be liable for a misdiagnosis if he/she followed the AMA's diagnostic discovery activity plan in determining the treatment plan that would be instantiated for the patient. 

Tort Case Limits Unimed would provide a malpractice insurance coverage to all health providers who elect to provide medical services under the plan, if they agree to follow the AMA's activity plans and have a history of quality of service. All malpractice cases would be paid from the Unimed malpractice insurance fund according to the tort judgment schedule that is in effect for the medical specialty involved. Unimed malpractice insurance limits for tort judgments would be configured by region and medical specialty.  In a perfect world, attorneys would be restricted to a 10% "cut" in medical malpractice litigation cases, from their 30 to 50% cut at present. If a medical practitioner desires to provide his/her patients with higher coverage limits, he/she can purchase a private Unimed Plus malpractice supplementary policy. 

Medical Review Board If a medical malpractice suit is filed against a health provider or hospital, the case must be brought before a local medical review board for the jurisdiction where the case was filed  The medical review board would determine if there are sufficient reasons to allow the case to go forward to the judicial system.  The medical review board must be created by a local election, and should be comprised of physicians, medical administrators, attorneys and patient ombudsmen.

Centralized Ratings System Unimed should provide a free health provider ratings and referral Internet website that would contain edited and verified reviews of participating health providers in each area, along with their credentials and area of specialization.  At present there are numerous ways to obtain physician reviews and hospital quality metrics, but they are neither verified nor centralized in one web site.

Portable Medical Records Portable health records would be available to all citizens, in the form of a portable USB flash memory chip that can be carried on their key chain.  The flash memory should contain the patient's standard XML formatted medical profile (TBD), along with any x-ray images, laboratory results, or special medical indications.   To insure HIPAA compliance, the encryption key to the flash memory chip data must be derived from the patient's own index fingerprint or other suitable biometric. 

Pharmacist Prescriptions In order to avoid unnecessary visits to their primary care physicians, pharmacists must be allowed to prescribe medications from a list of safe drugs.  These class-A drugs would not  be controlled substances nor drugs that require careful laboratory monitoring (TBD), but that are known to be safe for the condition the patient states at the pharmacy.  Other, class-B drugs would require a physician's prescription for the first use, but refills could be granted by the pharmacists for up to one year, at their discretion.

End of Life Treatment Most of the current Medicare expenses occur at the last 6 months of life.  It has been shown that there is a vast difference in the treatment given to patients who are in a terminal situation.  Unimed must provide a reasonable and humane coverage for this phase of life, including hospice care, but should not cover those medical procedures that would extend a terminal patient's life for a few more months or years.  Once a person has reached a certain age (TBD), life should be allowed to take it's course. If an individual desires to have additional end of life procedures covered, he/she may purchase a Unimed Plus plan that would provide it.

Medical Insurance in essence is a cybernetic system that requires a political will to be implemented.  We do not have a technical medical insurance problem, we have a political problem that has precluded the solution to the chaos we have at present, because our political system is based on the power of money and it's influence in Washington.  In a direct democracy, the People would have direct access to legislative power, via the Virtual Congress. We can not solve our problems if we are not allowed to at least openly discuss proposed solutions in the mainstream media. All of us are outsiders in this elitist system.

Atlanta, GA
May 14, 2008