Universal health care coverage through technology

Commentary. By Leonard J. Marcus, PhD, and Barry C. Dorn, MD, AMNews contributors. July 12, 2004.

COMMENTARY

Observations on the state of medical practice and medical life

SEE ARCHIVES

In this space on March 18, 2002, we proposed a rethinking and solution for the intricately related problems of inflating health costs and the expanding numbers of people living without health care insurance.

We called our intentionally pragmatic proposal the "three basket model" for resolving this enduring health care impasse. It is time to revisit the idea: The fundamental problem is not resolved, and recent developments and opportunities afford new credibility to the plan.

The purpose of the proposal is to reframe the working premises that have been employed to negotiate resolution of what has been a 40-year-old unresolved policy conundrum that continues to have shameful consequences for the American public. According to the Institute of Medicine, 43 million people in this country are uninsured, with the result that 18,000 people die prematurely and unnecessarily as a result of not having health coverage.

This proposal intentionally avoids the slogans and wording that have dominated the debate thus far, on the premise that part of the problem is that this question has been futilely entangled in a self-reinforcing swirl of rhetoric. It is time to renegotiate the operative assumptions and break free of the deadlock.

In this plan, there is the basic basket, the full basket, and the super basket of health services and associated fees. The premise of this formulation is that everyone in our country is entitled to at least the basic basket of health care services. This basic basket provides primary care services and a limited range of tertiary care.