Proposal: New Civil Service Branch

Rural hospitals are closing. Family medicine in rural communities is disappearing. And the lack of accessible healthcare in any impoverished community is deplorable. Recently, I mentioned the proposal to begin reforming the ACA (Obamacare) with a buy-in option for people at age 55. I am becoming more convinced that a single-payer system, “medicare for all,” is the way to go.

Reforming the payment for services highlights the need to reform the delivery system. I’ve been thinking about our current training system of medical personnel. Is the possibility of being very rich the sole reason people endure med school and residencies and debt? I don’t believe so.

One solution is to create a fifth branch of service called the Civil Medical Corp. This is separate from the people who train to be military medics, nurses, and doctors trading military service for their education. This would be a civil service commitment.

In exchange for post-high school medical training focused solely on the medical requirements for the chosen course of professionalism, the graduates are deployed throughout this nation in every community.

Civil Medical Corp members fulfill a period of service commitments, receive pay through the single-payer system or salaries like any other medical office/hospitalist and are “stationed” according to needs of the people through a state-based assessment and application process.

These medical professionals would take only courses necessary to become degreed. Medical doctors and all levels of nursing as well as the technical specialties would each have tracks. Thus training and deployments include MDs, xray techs, CNAs, RNs, etc.

Training focuses solely on the knowledge required to become prodicient in the chosen track. Problem-solving, critical-thinking, psychology, and communication are part of the process throughout. Limited electives allow recruits to broaden their interests, thus reducing the education by 2, 3 or even 4 years depending on the initial concentration. Field training through Internships would be required before deployment.

All first level Civil Medical Corp practitioners remain in the “service” for 10 years. Thinking specifically about doctors, after 3 years as a family practice or pediatric generalist, a doctor may apply for a residency in a specialty and return to study for surgery, etc.

The major disruption to the educational process for MDs is the change in undergraduate degree elimination. So a qualifying process and 1 to 2 year program of basic requirements would have to be developed.

I envision a process that moves a doctor candidate into obtaining a Bachelor’s of General Medicine–then 3 year deployment. The Masters degree would be the specialties, such as Emergency and Trauma or General Surgery or Dermatology. And the Fellow and Diplomate would be in ever higher levels of specialized care.

Associates for non-doctor tracks and Bachelors degrees are paid like we do ROTC, Masters level would be jointly funded by the individual and the Medical Corp. And anything after that is paid by the individual. Educational partnerships with states, institutions, and private investors may provide subsidized funding through scholarships or internship/work-study programs.

The appeal for the CMC to potential students is debt-free training and guaranteed employment.

Every community would have local access to the foundations of good healthcare.

Sound impossible? Every day we take 18 year-olds and hand them multi-million dollar equipment, train them to make instantaneous decisions over life and death, require them to be killers in our name, then send them all over the world to do their job. Regularly conversations erupt about spending more for the improvement of our nation rather than sending money overseas. Given these two considerations, shouldn’t we compensate a little by turning some of our kids into life-givers here at home?

Run with it, you who are are smarter than me.

Together We Can 

Ever walk into a nursing home and think you’d rather die than live there? 

Ever hear a story about someone’s heroic fight against disease or injury and think how did they manage?

Both circumstances have to do with community support. One has it and the others don’t.

Ever wonder how to make a difference in the world and leave the world a little better than you found it? The healthcare debate has a chance to begin anew. 

Consider a foundation of everyone helping each other so impoverished nursing home residents have the same opportunity to become someone’s heroic fighter that better insured and wealthier people already have. No one needs to suffer alone. We can do this together. We can pull together and do a better job sharing resources. To those of us who have we may have to offer a little more. But the end profit for everyone will be greater than if we hoard. 

Healthier people — better economy. 

Time for the Dems to Put Up a Plan

A few ideas for a good healthcare plan

1. letting people over 55 years old buy into Medicare.

2. Reduce out-of-pocket costs like copays and deductibles.

3. Reduce drug costs by 

  A. Stopping direct-to-consumer drug company advertising subsidies, and reinvest funds in research

  B. require pharmaceutical companies that benefit from federal support to invest a sufficient amount of their revenue in R&D, and if they do not meet targets, boost their investment or pay rebates to support basic research

  C. Require health insurance plans to place a monthly limit of $250 on covered out-of-pocket prescription drug costs for individuals

  D. Increase competition for specialty drugs including new “biologic” drugs – which are often the most expensive new treatments

  E. Prohibit “pay for delay” arrangements that keep generic competition off the market

  F. Allow Americans to import drugs from abroad – with careful protections for safety and quality.

 G. require drug manufacturers to provide rebates for low-income Medicare enrollees that are equivalent to rebates in the Medicaid program

  H. Allow Medicare to negotiate drug and biologic prices

3. Expand access to rural Americans, who often have difficulty finding quality, affordable health care.

4. Give authority to Secretary of Health and Human Services to block or modify unreasonable health insurance premium rate increases so that coverage is more affordable

This is not my thinking. It is part of the plan proposed by Hillary Clinton who actually worked for decades becoming expert in healthcare needs across the nation. This week the RNC tweeted a jibe against her, asked where her plan was, she gave them the link to her website and said “run with it. ”

I’m with her.

https://www.hillaryclinton.com/issues/health-care/

My Own Take on Medicare for 55 year olds

3 reasons to open Medicare for buy-in from 55 year-olds up to 65:

1. Healthier sub-group = more money in but less out = more money exchanged for other than healthcare goods = growing economy
2. More providers for preventative care = more steady guaranteed income for providers and negotiating power for Medicare = healthier middle-aged population entering older age = decreased expenses in later life = improved cash available for other purchases = growing economy.
3. Allows last of baby boomers to follow dream of entrepreneurial work without fear of insurance coverage loss = more good jobs for next generation = economic mobility = growing economy

Okay maybe just one reason: good for the economy.

This idea is a proposal from the healthcare plan of Hillary Clinton.  It’s time for the Democrats to put up their revisions for the ACA aka Obamacare.  This is a start. 

https://www.hillaryclinton.com/issues/health-care/

I’m with her.