The national health-care solution that works

Published November 7, 2013 by Neil P. McNulty

In the business world, before a product or service is launched nationwide, it is first “beta tested”, i.e., tested on a small scale before nationwide rollout. It is debatable whether such testing was conducted with current health-care reform, but there is a successful national health-care system for the uninsured that has been tested on a relatively small scale.

The United States Public Health Service (USPHS), one of the uniformed services, provides high- quality health services to the poor, the uninsured, and underserved. With only around 6,500 providers, their number is small. They have Navy-style uniforms and rank, but they are not a military service. USPHS physicians and other providers serve in inner-city clinics, poor regions such as Appalachia and other underserved locations. By every measure, theirs is a proven successful health-care model for the poor and uninsured. Has serious consideration been given to expanding the USPHS as a solution for national health-care reform?

With concerted national effort and increased funding, enough USPHS providers could be recruited and trained for assignment as augmentees to the medical staffs at all the nation’s hospitals. They would care for the uninsured, whether they arrived through the ER as most do, or the front door.  The number and specialties mix of USPHS providers on a hospital’s staff would be determined and requested by a hospital’s administration, not the government, as hospitals in low-income areas would probably need a larger and more specialty diverse USPHS contingent than hospitals in wealthier communities.

USPHS-provided care would be free of charge but not without limitations, which would be necessary because the purpose is provision of a safety net of care; the minimum level of medically necessary care for health, and not sufficiently attractive to cause the insured to drop their plans. There would be no choice of doctors, longer waits for nonemergency care, no elective care, only generic medications, closer scrutiny of admissions, and USPHS providers would be shielded from lawsuits.  Medically necessary treatments such as surgery or cancer treatments, which may be unavailable through a hospital’s USPHS staff, would be paid for through Medicaid.

Some would consider the preceding as too simplistic for health-care reform. Perhaps simplicity is what is needed. However, obvious challenges in implementation would include a significant increase in the USPHS budget, plus the time and expense involved with recruiting the necessary thousands of additional doctors, dentists and nurses for USPHS service. That might be mitigated by additional medical and dental school scholarship opportunities in exchange for USPHS service. The benefits include investment in a model and system, which has proved that it works, little involvement with insurance, no penalties to individuals or businesses that choose not to participate, and increased individual national service.

Neil P. McNulty is the president and CEO of the Virginia Business Coalition on Health, www.myvbch.org, a member of the National Business Coalition on Health www.nbch.org. These opinions are his own.