Malpractice Cost
The biggest challenge and issue facing medical care is the need for True tort reform. This will not happen as long as trial lawyers and other legal professionals dominate legislative bodies at the state and national level and this nation continues to be wanton in suits which are driving worthy people out of the profession without looking at alternatives to injury claims. On the other hand the artificial cap on pain and suffering at a ridiculously low figure such as $250,000 negates the true loss of lives unlived and families aggrieved. It is important to elect Dr. Ada M. Fisher because she understands the decision making process in patient care and that is needed to determine the standard of care and necessary services.

Nevada and West Virginia are fast losing surgeons, emergency room physicians and obstetricians/gynecologist who find themselves unable to purchase malpractice insurance in these states. Pennsylvania is teetering on this brink as well. Blue Cross and Blue Shield has begun to withdraw from options in Virginia. The folding of St. Paul's Medical Malpractice insurance for 2-300,000 physicians has been vastly underplayed and under appreciated in terms of its repercussions on how medical risk are dealt with. Daily physicians are leaving the profession because they are tired of federal regulations dictating how they may practice determined by people often with no medical training.

A solution - The need for arbitration panels to handle case reviews with the need for a definition of what is malpractice vs. misdiagnosis or lack of adequate testing due to funding limitations are issues which must be examined. Attorney recovery from such cases should be reduced to 25% including expenses.

A solution - true tort reform determined by significant input from non-lawyers, which will deal with malpractice justifications, arbitration options, etc. (Please note, this is not anti-lawyer. They have their place but practicing medicine is not their place and making the profession so defensive that it drives up cost with unnecessary testing is not the way to go.)

Contrary to espoused political views, there is no nursing shortage in this country. What there is, is a shortage of nurses who are willing to practice nursing under the present working conditions in the health care fields. Many nurses are selling real estate, teaching in schools, etc. rather than put up with the conditions of understaffing and inadequate resources they face in medical settings. Bringing these persons back to the field should be a priority.

Hospital Billing
We really don't know what health care costs, particularly hospitalizations because of our billing system. Presently if one is admitted for surgery, one may receive a bill from the surgeon, anesthesiologist, radiologist, pharmacy, radiology department, etc. Some bills may come in over one year after discharge leaving the average person with no idea to what it is in reference.

A solution - a one party or universal bill submitted for each hospitalization through the hospital within 30-90 days or the hospital absorbs the cost. Many health professionals will balk at this but in reality, hospitals dictate who can practice there, what services are offered and who may offer them; therefore, they should be responsible for billing cost imposed through their facility.

Medication Cost
Medications' cost cannot be contained without a serious change in how they are patented, researched and developed.

A solution - companies must have clear guidelines and accountabilities to state what they spent in developing medicines, what research has been involved in drug development, the risk and benefits of the drug, etc. Given this, they are entitled to recover cost plus 100% or they may be granted a patent for 5 years exclusively, then another 20 years with patent protections which would allow generics to be made (with companies making them) paying a percentage of their profit to the brand name company which originally developed the drug until the cost had been recovered.

A solution - drugs which must be prescribed by a physician, should not be advertised on television. Estimates place this cost at $6 billion annually, a savings which could be passed on to customers.

A solution - drug cost parity, i.e. making any FDA approved drug manufactured in this country which is sold in other nations purchasable at the market cost from those developed nations, such as Canada, or pharmacies could purchase them through that nation without trade restrictions.

A solution - drug development should be stimulated by federal economic incentives, particularly for those medicines which truly benefit society, e.g. vaccines and long acting medications for the mentally ill. Liability for such medicines must be had.

A solution - fines and censure should be considered for price gauging and wrongfully prescribing medications which may not be indicated.

It is wrong to grant to one segment of the population a prescription benefit when small businesses and the "working poor" bear the brunt of the costs and can't afford the cost of insurance or medications, yet their taxes go to support these programs. People are appealing to the elderly because they know they vote. However, we will rip our society apart and have an inter-generational war if the elderly do not realize that if those who pay the taxes, can't get these benefits as well, when workers become ill, they can't pay the taxes from which benefits accrue.

Health Insurance
In my walks now through all 100 counties and over 189 cities, 60% of the small business people I met had no health insurance. The cost of Health Insurance or who should provide health insurance is basic to discussions on health care affordability, accessibility, and equity. Many of our First Responders, teachers, and public servants were in these jobs for the health benefits they received not the salaries. A major fallacy in our health system is the tying of benefits to ones job which wrongly assumes everyone will have a job.

A solution - portable benefits should be considered in this highly mobile society.
-Worker choice in coverage, i.e. companies should give their employees the portion of the cost the company assumes for a reasonable policy and let worker's decide for themselves what they want and need. This puts the burden on insurance plans to be competitive and make clear what options are available through them. This also keeps employers out of people's personal business and will eliminate them from practicing medicine by establishing their own health care cooperatives. If companies would make their own products well they would probably be a lot better off. In trying to do other ancillary services such as health care in which their qualifications are limited and their bottom line is cost, companies are stepping into a liability quagmire which most don't need to assume.

A solution - The NFIB would like its members to be able to purchase insurance as a group. I have no objections to this or the same being extended to those who belong to a church, sorority or fraternity, or any other collective body. The government of states could even look at doing this for its Medicaid, SSI, or Medicare recipients.

A solution - the government's role in this should be to establish a minimum level of services health insurance companies should provide in their Basic coverage (which may be the same as provided by HFCA rules for Medicaid and Medicare); Standard coverage (might be a step above this with short-term rehabilitation services, out-patient mental health care, nutritional services, medication discounts, etc.); High option coverage (might additionally include dental, mental illnesses, and long-term care). HFCA or some other panel under government oversight should decide which services are covered without political manipulation or interference.

If the government would let the private sector assume the burden of dealing with health care costs, they might come up with innovative solutions to high prices. As long as the government stays in health care, people will want more services for free and taxes will continue to escalate.

The call for tax credits or tax deductions for insurance payments rings hollow when one realizes that a $1500 tax credit means nothing when you have to spend $7000 on your deductible. Or what good is a tax credit if your premiums are $900 per month. A medical savings account faces the same problems. It only works if you never need health care and/or if you have a job which pays health care benefits. All of this is pandering for votes rather than trying to deal with workable solutions to the problems. I will not go this way. I want solutions which aren't band-aid approaches but rather options which address our long term needs and will help our people.

The Medical Model vs. the Public Health Model
Health care needs to be refocused from the disease medical model to the preventative services model.
 

To try to fix things after they are broken is much more expensive than to keep things tuned and running smoothly. Citizens must understand that they can't continue with awful habits and counterproductive lifestyles and expect the government or others to constantly bail them out.
 

A solution - deliver reimbursable low cost screening test and immunizations through the county public health department rather than through individual practioners where cost vary depending on insurance options.
 

A solution - in remote areas let the county public health department add options such as rehabilitative and expanded mental health services.
 

A solution - A national system of emergency care should identify hospitals within 50 miles of county seats as a catchments area for that county. Federal reimbursements for these hospitals would be at least 10% over the allowable HCFA rates.

A solution - more support for Hospice services which are one of the best bargains around.
 

A solution - The absence of mental health services to those who need it most and the trend away from institutionalization, witnessed the closing of mental hospital beds and services. Hospitals, which provide "holding services" for individuals so affected, should likewise be reimbursed at least 10% over the allowable HCFA rates. These options would allow some centralization of essential services within a county, accessibility to care, and provide a decent reimbursement on the cost. This would attract providers to these areas

Health Provider Distribution
I see evidence of the abandonment of rural America as a place to practice medicine which is having a negative impact on industry and economic development for these areas. Hyde County now has one physician who is 85 and no pharmacy. I have seen other counties with a doctor only 2 or 3 days a week or those staffed by mid-level practitioners with supervisors a county or more away. This is no way to deliver health services.
 

I find it frightening that many of our smaller cities are nothing more than bedroom communities for large urban areas. The identity of America is fast becoming lost with the dwindling of underpinnings from rural America. Many young professionals aren't interested in these areas.
 

A solution - The National Health Service Corps was started to address the question of practitioner distribution. It's time to cut federal funding for professional education without a concomitant service commitment to these areas. (No manipulation of Congressmen this time for prime urban locations as exemptions as was previously done.)
 

A solution - Change the reimbursement rate for hospital care to these areas to make them more attractive places to practice, i.e. an area of need is reimbursed 10% higher than others with a teaching hospital getting another 10% boost.

Health Provider Training and Licensing
Our health care providers aren't necessarily serving where they are most needed. Many tend to be clustered in urban or suburban affluent areas with the most modern facilities. Rural and remote areas where much of the work keeping this nation fed and clothed is being done are being left out of the provider supply side of this issue. This must be addressed if these areas and their citizens are to survive and prosper. This is a critical economic development issue.
The malpractice burden and limitations on the practices of physicians will see many rural women without obstetrical care, ill prepared primary care people for solo and rural areas, and swelling ranks in our big cities where the best and brightest will flock if we don't look at how we train people at every level for medical services. The role of mid-level practitioners, alternative medicine and other valuable adjuncts in health care must be explored not as a cheap alternative but because the care provided will be demonstrably good. The cost of education for the professions is becoming such that only the academically brilliant, rich and well connected can afford these career opportunities. Change must happen if people are to be medically served.

A solution - some consistency in licensing between all states, maybe a universal national license.
This would also allow emergency response preparedness in case of national disasters or trauma. Licensing autonomy and authority by each state allows practitioners to move around in a manner that is often difficult to trace. The cost of licenses may also be stifling, e.g. NC is $450 initially, IN $30 for renewal, etc.

A solution - reimbursement of any federal training cost at a higher rate for primary care providers.