Building a Unified American Health Care System

Building a Unified American Health Care System: A Blueprint for Comprehensive Reform

Description:
A blueprint for comprehensive, science-based health care system reform.

Financial and political pressures on our health care system have negatively impacted individual care and the health system as a whole, an issue that has only become more acute because of the COVID-19 pandemic. In Building a Unified American Health Care System, Gilead I Lancaster, MD, lays out a blueprint for comprehensive health care reform, proposing a unified system run by health care professionals―not politicians or commercial health insurance companies―that offers universal coverage and access.

Lancaster compares the current arguments for single payer versus commercial health insurance systems with arguments in the early 1900s for a central bank versus regional commercial banks. He then introduces a novel solution: the establishment of a National Medical Board similar to the Federal Reserve System that helped fix the American banking system over a century ago. Along with other innovations, a plan co-created by Lancaster dubbed EMBRACE (Expanding Medical and Behavioral Resources with Access to Care for Everyone) would involve creating a modern, evidence-based health care system, one offering universal coverage for basic needs while allowing for commercial insurance participation. Emphasizing the importance of separating health care from governmental and commercial pressures and incentives, Lancaster explains the need for comprehensive―rather than incremental―reform of the American health care system.

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Introduction

Even before the COVID-19 pandemic began in 2020, the US health care system was already showing signs and symptoms of ill health. One clear sign was the large number of attempts to reform it and one clear symptom was how ineffective and inefficient the system was at delivering health care to the American public.
More than any other developed country, the United States has been grappling for decades with how to provide health insurance to its population, especially its most vulnerable. But the COVID-19 pandemic has made clear that the problem isn’t just of how many Americans have insurance; it is also the challenge presented by an archaic and decaying infrastructure rooted in the twentieth century that is not prepared to take on the challenges and demands of a modern, science-based health care system.

In this respect, most approaches to health care reform have neglected the true causes of the system’s dysfunction, namely its lack of a unified infrastructure and oversight. Instead of addressing these “bigpicture” issues and tackling root causes, lawmakers have found it easier to nibble around the edges and focus on a few of the most evident problems (like the number of uninsured or the use of preexisting conditions by insurance companies to deny coverage).

Physicians know that a systemic disease like diabetes can affect many organs. They can treat the heart, eye, and kidney diseases that the diabetes has caused in a patient, but they know that until they can effectively control or cure the diabetes, these treatments will be less effective, and the organ problems will continue.

It is therefore not surprising that it took a group of physicians (and other health care professionals) to recognize that the US health care system suffers from a “systemic” disease. Consequently, the group endeavored to address underlying problems the same way they might treat a systemic medical condition: with evidence-based solutions.

This group of nonpartisan health care professionals believed that discussions of reform needed to address the broader more pernicious problems and be led by health care professionals rather than by politicians, insurance companies, and partisan thinktanks. With the aid of health care economists, public health experts, and lawmakers, the group ultimately developed a holistic health care reform proposal that they called EMBRACE (Expanding Medical and Behavioral Resources with Access to Care for Everyone). Their proposal was first published in 2009 in the Annals of Internal Medicine. Over the past decade, the plan has continued to evolve and improve. This book presents the latest version of EMBRACE.

It needs to be understood that the comprehensive discussions about the health care system covered in this book involve a whole host of disciplines. These include, but are not limited to, public health, economics, history, health policy, public finance, information technology, and even banking reform. All are robust academic fields in their own right but are seldom discussed together when considering health care reform, as in this book. This presents a unique opportunity not only to explore these varied disciplines but also to see how they might work together to find new solutions for what has been a vexing problem.
Banking and financial reform is not often identified with health care system restructuring. Yet the examination of the politics around the creation of the Federal Reserve is a particularly important aspect of Introduction  the EMBRACE proposal. Although it was not the first to propose a semi independent medical board based on the Federal Reserve,1 the plan is the first to fully integrate it into a holistic vision for health care system reform. For that reason, this book will provide added focus on the historical and political parallels between the banking and financial turmoil of the early twentieth century and the current situation in the American health care system, and what we might learn from such parallels.

Of course, when dealing with this number of wide-ranging disciplines it is not possible to do justice to all the potential contributions of each. Instead, this book endeavors to extract the important elements of each field and demonstrate how they can be coordinated in a cohesive health care reform solution. The intent is not to present an exhaustive dissertation on the state of the American health care system, since that has been covered quite well by others,2,3,4 but rather to explain the need for its across-the-board reform.

Although this book is evidence-based, it is written for a broad readership who may not have a background in the many disciplines that are covered. Wherever possible, the book provides references to the supporting documentation that are accessible on the internet to assist the reader in further exploring the complex issues that surround American health care.

 

Table of contents :
Cover
Half Title
Title
Copyright
Dedication
Contents
Foreword, by Congressman Jim Himes
Foreword, by David L. Katz, MD, MPH
Acknowledgments
Introduction
1. The American Health Care System Disorder
2. The Ideal American Health Care System: A Wish List
3. Health Care and the Economy
4. Lessons from the Creation of the Federal Reserve System
5. How a National Medical Board Can Help the Current Health Care System’s Problems
6. EMBRACE: A Comprehensive Plan for Health Care System Reform
7. The National Medical Board and the Federal Reserve System Compared
8. Anticipated Impact on Health, Health Care, Business, Innovation, and Government
9. Cost Considerations
10. Implementing EMBRACE
11. Political Considerations and Advocacy
12. Questions Answered
Abbreviations
References
Index