Reform Proposals:

1. Enact legislation to create more insurance company competition. This would promote competitive pricing and improve efficiency. Therefore, reform should include enforcing current laws and creating new laws if necessary to promote competition and reduce insurance administrative service costs. The current average insurance retention of 15% of premium is excessive and could be reduced to 10% or less without compromising access or efficiency. Administrative services include (a) benefit plan creation, (b) enrollment, (c) premium collection, (d) provider credentialing and contracting, (e) claims adjudication, and (f) benefit plan coverage interpretation and benefit dispute resolution.

2. The federal government should create a “no-fault” dispute resolution process to adjudicate malpractice complaints to replace the current “tort” process. The “no fault” process can be modeled after the Federal Vaccine Injury Compensation Program (FVIC) using a federal minimum standard whereby the court asks if the condition was avoidable and a result of the treatment. In addition, the federal government should enact legislation to require that administrative court processes, such as mediation or arbitration, precede any tort action in all alleged malpractice disputes.

3. The federal government should modify, simplify or eliminate laws, regulations and/or accreditation requirements which do not improve patient safety, quality, access, nor prevent fraud or abuse as determined by independent analysis based on objective risk/benefit criteria. Examples include (a) eliminate the requirement that providers report a diagnosis (ICD10) to get paid for services rendered in that consumption of resources is not related to diagnosis; (b) eliminate the National Practitioner Data Bank in that tort does not identify negligence; (c) eliminate Stark regulations that don’t prevent fraud; (d) apply HIPPA privacy regulations to research providers only, in that during the almost twenty years since enactment, there have been few non-research institution-related provider prosecution.

4. The federal government should retain those regulatory agencies which improve patient safety, patient access, service quality, or prevent fraud or embezzlement as determined by independent analysis based on objective risk/benefit criteria.

5. Remove the federal and state legal obstacles to delivery system reform. Federal legal obstacles are found in current antitrust laws, incentives which limit service prohibition, federal medical payment policies, privacy and security laws and anti-kickback laws (Stark II). State legal obstacles are found in current corporate practice of medicine laws, scope of practice limitation laws, and certificate of need laws.

6. Remove all mandated benefits (state and federal) for services that do not prevent, diagnose, treat or rehabilitate injuries and illnesses.

7. The federal government should prosecute individuals and organizations that commit health service embezzlement and fraud.

8. Re-structure the health care financing, delivery, regulatory and legal systems to support the creation of a “medical home” for all citizens whereby the patient and their selected primary care doctor are the coordinators and decision makers of health care services.

9. Remove federal and state current obstructions to consumer provider choice. An example of a current obstruction is the limitation of Medicaid insurance products to HMO products only.

10. Re-structure the health care financing, delivery, regulatory and legal systems to ensure that local health professionals have controlling authority to determine the medically related management decisions and processes within medical groups, health care facilities, and other health care delivery organizations and systems.