The Socialist Healthcare Manifesto: A Paradigm Shift to Stop the Madness

[Note: I apologize if this offends truly empathetic doctors who are not out solely for money. If this paradigm shift happens, I think you'll enjoy no longer chasing after the greenbacks but concentrating on your noble profession the way it was meant to be.] [The name UniCare is used here and I apologise for its use if it has intellectual property protection from elsewhere]

I hope everyone knows the meme that we pay the most of any advanced nation on Earth and yet receive care that is--putting it kindly--less than optimal. How do we correct this imbalance? We can try incremental changes as has been proposed by the GOP but this smacks of duplicitousness because they most likely would not want to implement the second change until the first has succeeded and that could take decades. I'd go with their suggestion, however, if we could implement each change before previous changes had run their course; otherwise, how will we know of the negative interactions between them? But let's dive right into my proposals, shall we?

1. Diagnosis
• The first order of business is to have the patient go to a diagnostician who uses computer assistance (UniCare Software or UCS) and testing to properly diagnose the patient's condition. How many of us have gone to a doctor only to have the doctor try this or that until he hits on the right treatment? A doctor goes to medical school for over a decade but invariably his diagnostic work turns out to be a trial and error process (he'll never admit to it but it is often the case). It would be nice if one doctor could do diagnosis and treatment but it's inefficient at best. The expert that we need--with few exceptions--only does diagnosis and nothing else. This diagnosis is passed on to the proper specialist who then provides the necessary treatment, again, with computer assistance that provides him with protocols to follow. BTW, there may come a day when a medical school degree would only be required of the diagnostician and surgeons who require more advanced training (neurosurgeons, heart and orthopedic surgeons).
• Pregnancies would probably require birthing centers where woman can go to get prenatal care and obstetrical procedures.
• The main cost advantage is that with specialization comes increased accuracy. Costly inefficiencies like improper diagnoses are minimized. Also, pharmacists and nurses can do diagnoses of more common ailments; referring the patient to a specialist diagnostician if unusual elements present.
• The treatment doctors also get a detailed diagnosis; you don't just get diagnosed with high blood pressure, you are told what's causing it (when possible) and, when there are multiple causes, what is the percent that each is likely to be contributing (ie. 30% weight, 30% diet, and 40 percent smoking)
2. Treatment Doctors
• Here we can establish various tiers or categories. Although all information will be on a cloud, the patient will have a hard copy of the diagnosis for verification purposes.
1. Medicinal treatment of common ailments treated with relatively benign drugs. The patient is given the option of seeing a nurse practitioner or a pharmacist when medically appropriate. An incentive might be to offer a zero co-pay when you go to a non-MD/OD for treatment.
2. Medicinal treatment of more unusual ailments treated with drugs requiring extra care. Here you might encounter anti-coagulants, chemo, etc.
3. Surgical Centers. If the diagnostician determines that you need surgery, you will go to a public non-profit (UniCare) surgical center where highly trained and highly specialized surgeons will operate on you. At first, these centers could be part of the Veterans' administration hospitals. If the surgery is needed ASAP, the patient can go to a private hospital where costs will covered by UniCare. Emergencies like heart attacks, trauma, and others can be handled by private hospitals where, again, costs will be covered with no out-of-pocket expenses but the private hospital must determine if it's a true emergency; if not, the patient is referred back to a UniCare hospital.
3. Laboratory
• Today, laboratories and imaging centers respond only to a Dr's script and they provide results only to the doctor. It's time to change this paradigm.
1. The prospective patient should be allowed to request any diagnostic procedure that is not invasive (venipuncture allowed). However, he or she must pay for the test out-of-pocket, but if positive results are returned, his expenses are refunded. What is the advantage here? Let's say you suspect you have a medical condition but would like to try and treat it yourself via alternative medicine or lifestyle changes, this will allow you to do that. Further, you've avoided that first visit with the GP--saving money--and have possibly made the diagnosticians' job more efficient with results in hand.
2. What does providing results only to the doctor mean? First thing it means is that you need to go see the doctor and pay for the visit before you know anything. If the results are totally negative, there is no justification for a visit but we find that at the time the doctor orders a blood test, you are given an appointment for your next visit to discuss the results; results that may in fact be negative. Also, some results are borderline and do not require immediate and aggressive treatment.
• There is something else that could go a long way to fixing our healthcare. By giving the patient copies of all lab/imaging work, the physician is kept on his toes for now if the patient should die, the family has the data in their possession with which to pursue a malpractice claim. Sometimes, it's not incompetency on the part of doctor--it's that, as a businessman, he's motivated to "keep things moving," at a detriment to the patient. Along these lines, something else that might be beneficial is that the patient has all the time in the world to keep track of his numbers and is more likely than the busy doctor to see important trends. Please remember that the only time a doctor gets to see trends is during your visit--will he/she spot it within the time they give themselves?
4. Oversight
• I've heard it said, half-facetiously, that physicians bury their mistakes. But the truth of the matter is that nothing could be closer to the truth because there is no proper oversight.
1. When someone dies at home, the cops question family members with an eye to uncovering wrongdoing. However, who investigates the medical practitioner at the time of his patient's death. Absolutely, no one. In fact, whatever the doctor says is taken as the gospel truth--if he's even questioned at all. There is no investigation, no pouring over the patient's chart to look for signs that the doctor may be incompetent. While it may be too much of burden to do this in every case (though, I personally don't believe it is) there is no reason why a government agency can't randomly select doctors (like the IRS does with tax returns) and look at how they are handling the care of their patients. I propose, three strikes and you're OUT, you've lost the right to practice medicine. This auditing should be for all physicians not just those accepting UniCare patients.
2. Diagnosticians' ability to properly diagnose will be rated and action taken to correct. Any changes in diagnoses must take place after consultation with the diagnostician.
5. Medication
• Medication is expensive but there are ways to lower costs
1. Others have proposed buying at the same cost as that which Europeans or Canadians pay. Definitely a good move but what's the hold-up?
2. Why should any patient who has a chronic illness that requires meds for the rest of their lives need to go back 4 times a years just to get renewals? The answer the AMA would tell you is that the doctor needs to assess or look for adverse effects but how does the doctor assess these effects? Is it not via lab tests? The renewal of medications under Unicare would require a patient--in lieu of seeing the doctor 4 times a year--to undergo pertinent testing. If the results are problematic the patient then makes an appointment with the doctor and if he doesn't make an appointment, his renewals can be cancelled.
3. At the FDA end, there is no reason why medications can't be introduced into the market without efficacy testing but with extensive safety testing. So, if the doctor and the drug manufacture believe there is reason to expect a product to work, give it a try; if it doesn't work, the patient gets his money back. The market will determine if a product is efficacious, and, if it just has a placebo effect, well, what harm is done?
6. What can Cuba do for us?
   
   • Cuba has a program where it trains doctors and the only payback is that they (the students) agree to work in a disadvantaged neighborhood ANYWHERE in the world for a certain amount of time. This appears to be a win-win and one which should be looked into.
7.  The patients' role
• The patient is asked to conform to certain requirements
• DNA analysis should be required at the start of UniCare enrollment with an initial aim of determining known risk factors. All medical personnel would have access to these results with the patient's' consent.
1. Let's say the diagnostician determines that you have hypertension (you went to him/her complaining of "not feeling yourself"). He sent you to a cardiovascular specialist (or cardiologist or I.M.) who then tells you that you need to lose weight and take some pills for the time being. OK, you do the pills, the blood pressure goes to normal but the specialist (or G.P.; tbd) follows a government/university issued protocol that insists you also lose the weight (UniCare doesn't want you on meds if it can avoid it). Follow the protocol and you're on the road to recovery. Don't follow the protocol--especially that weight loss thing--and a surcharge would be added to your taxes and continue for every year you don't lose the weight. When losing the weight, you won't be left out in the cold (we're not those other socialists, you know). Instead, you will be offered treatment plans that involve exercise, diet, meds, surgery, and psychology.
2. We wouldn't want to hurt the patient who has decided to go with a private insurer, and personally-selected doctor, so whatever this patient pays is offset by the amount UniCare patients are paying for similar services.
3. Patients judged to be hypochondriacal or otherwise abusive of the system as shown by patient history, will be referred to a diagnostician for evaluation.
8. Computers
• Extensive use of computers should be undertaken for every UniCare patient
1. Patient records are kept on the cloud and accessed via a UniCare Medical ID.
2. Artificial Intelligence will go a long way to ensuring the best care. The diagnostician will have an entire medical "library" at his fingertips. At one point, he'll be able to take a picture of a rash and determine its etiology. The nature of A.I. is that the more data is entered, the smarter it gets.
3. Artificial Intelligence will also help the prescribing doctor, nurse, or pharmacist. The treatment option with the highest rate of success will be shown first; however, these protocols will have options in order to address patient issues like compliance, adverse effects, affordability (hopefully, price would one day be a non-issue).
4. Any future treatments will always be checked against pre-existing patient history to determine contraindications.
5. Dietary advice will always be provided depending on the patient's illness. For example, a gout patient will be advised against eating sardines or high amounts of animal protein. A kidney stone patient will be advised against drinking too much beer or eating too much spinach. Nothing should be left up to the imagination of the patient or the failings of the treatment professionals. If put on a special diet, patients may give permission for an app to access their food purchases with an aim to determine calories and nutritional benefits or lack of and providing alerts and advice for better purchasing decisions. [if you don't lose the weight, you incur additional surcharges]
9. Implementation
1. Medical universities and teaching hospitals should start immediate development of the A.I. programs that will be used by all personnel at every stage of care. Common diseases will be addressed first with less common diseases entered as they occur.
2. I am not an economist but it would seem to me that something as important as one's health should be well-funded. I propose a progressive health surcharge tax on all sources of income. The rates of which are expected to go down as UniCare increases the efficiency of medical care. All who contribute to the fund will benefit. Those who opt for private insurance and doctors, will get a discount equal to what their doctors would have received under UniCare.
3. Establish a centralized national testing laboratory (NTL). Existing laboratories can do testing if they are willing to accept the costs of the NTL for the same test plus a reasonable handling fee.
4. Start enlisting physicians who want to specialize only in diagnosis. The A.I. program can, during the diagnosis stage, recommend treatment for simple acute disorders. For example, ear drops for an ear infection or other acute localized infections, creams for a poison ivy rash, etc. These can be prescribed by the Diagnostician in the interest of efficiency. If a physician wants to do both diagnosis and treatment, he may, of course, do so but when servicing a UniCare patient, UniCare software must be used along with agreed upon fees.
5. Establish surgical hospitals, one per every--to be determined-population size. Initially, these will be used for the most common procedures: gallbladder, kidney stone, etc.