An Insider's Solution to the Health Care Crisis: A New Model of Health Care Delivery

This book presents a bold and comprehensive proposal for addressing the ongoing health care crisis in the United States, focusing on a hybrid health organization (HHO) plan that aims to improve access to care while controlling costs. The author, Dr. Eugene H. Schmitt III, draws upon his sixty years of extensive experience in health care to highlight the systemic issues plaguing the current health care delivery model. The book identifies critical problems within the current health care system, including rising costs and limited access to care. It emphasizes that the existing model, which assumes that all medically indicated care should be covered by insurance, is unsustainable due to the increasing complexity and expense of medical treatments. Proposed solutions Dr. Schmitt's HHO plan breaks down medically indicated care using ICD-10 and CPT codes into four distinct categories: basic, lifesaving, and catastrophic (which are essential), as well as elective. This categorization allows for different payment structures and prioritizes essential services while offering flexibility for elective procedures. Basic care: Defined as essential, preventive, and urgent care, basic care is to be funded through health savings accounts (HSAs) with state government support for low-income individuals. Lifesaving care: Managed through capitation fees paid directly to hospitals/health care systems, this level will incentivize cost control and quality care. Catastrophic care: Funded by federal government reimbursements for costs exceeding a set threshold (e.g., $250,000), this category will ensure that high-cost treatments remain accessible. Elective care: Covered by optional health insurance policies, this form of care will allow patients to choose the extent of their coverage. Implementation steps Dr. Schmitt suggests four critical steps in implementing the HHO plan: Allow pretax deposits into HSAs for all medically indicated care. Enable hospitals/health care systems to contract directly with payers for lifesaving care. Modify Medicare to accommodate catastrophic care for individuals under age sixty-five. Allow health insurance companies to offer standardized policies for elective care across state lines. Dr. Schmitt acknowledges that the proposed changes will hinder several special interest groups that have benefited from the current health care system. Nevertheless, he advocates that these changes be implemented, as these groups should never have benefited at the expense of patient care and human lives. The book argues that the HHO plan is viable due to the growing public outrage over rising health care costs. Meaningful change is possible with bipartisan support, as both Democrats and Republicans can find common ground in the need for universal coverage and cost control. The book concludes with a call for action, expressing hope that the HHO plan can serve as a catalyst for the meaningful reform of the US health care system. There is a need for collaboration among all stakeholders, including patients, providers, and policymakers, to ensure that health care serves the public interest rather than corporate profits. The proposal is a detailed and thoughtful examination of the complexities of health care in the US, with a clear focus on creating a sustainable and fair system for all. Read more