Honorable Steve Kagen, M.D.

Wisconsin's former 8th District Representative

January 4, 2007 to December 22, 2010

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Health Care

Posted on Jun 8, 2009 by

THE ESSENTIAL ELEMENTS OF HEALTH CARE REFORM

PRINCIPLES:

1. The quality of the patient experience must constantly be improved.

2. The root causes of waste must be continuously discovered and removed.

THE 10 ESSENTIAL ELEMENTS OF HEALTH CARE REFORM

1. There must be No Discrimination in access to health care, anywhere in these United States. When applied to the health care marketplace, No Discrimination means that everyone within the region will be able to pay the lowest price at the pharmacy, doctor’s office, and hospital – because to charge someone more than another is a form of discrimination. There is no reason you should be asked to pay $10.00 for the identical pill that someone else is receiving for $1.00, nor should you have to pay $1,400 for an MRI that the next patient receives for $413. The common practice of charging different prices to different customers for the same medical service or product is discriminatory and must come to an end.

2. A Standard, Comprehensive Third Party Health Care Plan (Standard Plan) must be available to all citizens and legal residents; one that covers medical services and products for basic preventative care, episodic acute and chronic care – including coverage for prescription medications, dental care and mental health conditions.

A key component of any standardized health care plan must be an accommodation for payment reforms that encourage improved health outcomes, focusing upon population health improvement and patient condition care. And when each and every insurance company is forced to sell the identical Standard Plan within a Metropolitan Statistical Area (MSA) without being able to discriminate against any citizen or legal resident due to any pre-existing medical conditions, while openly disclosing their prices, we will finally be able to compare insurance companies based upon the quality of their service and their price. The sale of the Standard Plan as a basic policy will also compel insurance companies to compete against one another in an open and transparent marketplace, driving down prices for all of us.

3. All costs for the Standard Plan, as well as any and all medical services and products associated with it, must always be Openly Disclosed and Transparent, allowing every citizen and legal resident to purchase these essential services and products at the lowest prices available within specific Metropolitan Statistical Areas.

Costs for such coverage and care must be Tax Deductible for the sponsoring entity, and for all health care consumers, and including costs for all prevention services covered within the Standard Plan. Given this Standard Plan as a base, costs for additional coverage for medical services and/or products above and beyond the Standard Plan would also be tax deductible. Without the Standard Plan as a base, however, no costs would be tax deductible.

4. Government sponsored health care plans must be designed to reward successful performances and patient outcomes with Financial Incentives that constantly Remove Waste and Improve the Quality of Care. To control health care costs and bring an end to the Cost-Shifting of uncompensated care to private payers, all government sponsored programs, including Medicare and Medicaid, must provide payments that at a minimum cover the overhead costs associated with the provision of medically necessary products and services.

(A public-private facility must establish Measurable Goals for all those involved in the delivery of health care services and products, focusing on both the efficiency and quality of their performances; and a standard set of measurements should be created to report such measurements publicly.)

5. Pharmacists, as certified health care professionals, must be recognized and rewarded for their essential role in securing patient’s access to the best health care outcomes; for improving compliance with prescribed therapies; for monitoring and managing chronic care and preventing readmissions to hospitals, nursing homes and emergency wards; and for reducing waste, fraud and abuse at all levels of care.

Reforms that seek to regulate Third Party Formulary Determinations and the appropriate role of Pharmacy Benefit Managers must require complete transparency of all financial relationships and must be based only upon doing what is best for the patient.

6. A common set of Information Technology Protocols must be established to enable different health care delivery systems to immediately communicate with one another, enabling caregivers and their patients to benefit from advances in electronic medical records.

7. There must be a coordinated effort between government and private entities to establish Catastrophic Re-Insurance Coverage with a federal safety net for all citizens and legal residents.

8. Sufficient incentives must be created to encourage careers in Primary Care, Non-Specialty Care, Nursing and Pharmacy, including programs to promote minority participation in health care careers everywhere.

9. The federal government must Measure the Effectiveness of all health care services and products, and provide financial incentives that promote Transparency of Costs and Outcomes for all health care providers, and the results of such outcomes studies must be made openly available to the public.

10. There must be Financial Incentives throughout the health care delivery system to Discover and Eliminate Waste, while simultaneously meeting or exceeding quality outcome expectations; a key component of this being the development of Population Health Management and payments being made to providers for care across time in the management of a patient’s condition – thereby rewarding prevention strategies instead of procedural, episodic care.

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