How To Fix The Healthcare System by Our Readers

There are thousands of you who read this blog.  Most of you are in the healthcare field.  All of us are patients.  How would you fix the healthcare industry to make it better?  I have been collecting some great ideas to spread them around.   Read what people have sent in below. I am sure they are better than what the idiots are offering right now.  Please keep adding on by posting below and I will continue to grow the list.   I would love some specifics but if you want to give some ethereal and dreamy visions (everyone should smile everyday) then go ahead.

  1.  Alter the ratio of administrators to doctors (now at 5 to 1)
  2.  Eliminate red tape
  3. What I’m looking for are “meaningful use” measures that are actually meaningful and useful to patients and care providers.
  4. Eliminate Core Measures.
  5. Full loan forgiveness for all residents who complete FP, pysch, ob/gyn residency.
  6. Stricter boards/testing for nurse practitioner certification.
  7. Drug rep beneficiary standards: Any physician who accepts gifts totaling more than 2 standard deviations above the mean physician is banned, under penalty of revoking licence, from receiving any gifts for 3 years. (now give me my pens back)
  8. Insurance that covers cost–without any sort of copay–for one yearly physical/preventative checkup. Reimbursement for preventative care is tripled.
  9. Create national board of physicians that determine best practice and acceptable practice guidelines that are binding for insurance. Any physician practicing within them is approved and reimbursed without question, patients benefiting from them are covered according to their insurance terms.
  10. Create state level ‘boards of peers’ that determine viability of all malpractice suits. Lawyers, judges, and juries will still try the case, but the ‘board of peers’ will determine whether the medical decisions made were questionable enough to merit trial. Motions filed to and dismissed by the board are expunged from the physician record.
  11. Arrest Jenny McCarthy for crimes against humanity, gross child abuse, and gross negligence.
  12. Eliminate cost deals between insurance providers and hospitals. Cost is cost, everyone should pay the same amount for the same procedure.
  13. Require all alternative medicine and manufacturer health claims to undergo the same scientific rigor that FDA approved drugs do. Payed for by the companies promoting their woo.
  14. Make drug advertisement illegal outside of medical journals/etc. If you make a good drug, the docs prescribing it will rake in more then enough for your company (if the best/acceptable practice is instituted)
  15. Phase out Medicare entirely; admit that any program that makes a that allows unrestricted demand will ultimatley lead to cost overruns and rationing.
  16. Eliminate Medicaid at the federal level; return all of it to the states to continue or abolish as they will.
  17. Encourage patients to forgoe standard health insurance in favor of major medical. Realize and admit that the purpose of insurance is not to provide preventive or routine care, all of which adds to the rising costs.
  18. Admit forthrightly that health care is not a right; that declaring a good or service a “right” only leads to shortages.
  19. Beginning in medical school, encourage students toward cash-only/salaried positions untainted with core measures, “best practices”, reibursements, ICD/CPT garbage; strive to return the patient-doctor relationship to one of value-for-value equals where the customer can demand value on the basis that he is the one paying.
  20. Stop the bloody arrogance! Force the do-gooders in our profession to see that every mandate they call for, every swipe they take at straw dog drug companies over a cheap steak dinner, every puffed-up editorial they write calling for someone else to sacrifice in order to secure their own well-being ultimately hurts every one of us.
  21. Refuse to see medical malpractice lawyers. And yes, I am deadly serious about that.
  22. At the heart of all this profession’s troubles is a disease of philosophy. Until this is dealt with, we will not get better.
  23. set prices for all cpt’s (ie each gets paid the same all over the country) like japan has done.
  24. disallow facility fees
  25. disallow preexisting conditions
  26. set prices for all insurance policies yearly (like japan)
  27. more training and supervision for all physician extenders/noctors
  28. state run medical court system
  29. make congress buy their own insurance.
  30. We have done such a great job of increasing life expectancy in this country that end-of-life, and quality-of-life issues are becoming increasingly important. The system is not broken, it is just over-stressed. So how about we leave the healthcare system alone….it is working as needed. Let’s get back to the cause of much of teh costs associated….by attacking obesity. Here is my idea, and solution….  All foods, I mean ALL FOODS and anything consumables, are charges BY THE CALORIE!! Just like high-octane fuel, get pay more if you get more!!  Think about it….bagels cheaper than donuts. Low-fat foods cheaper than high-fat foods. Fresh fruit and veggies cheaper than canned. Low-fat milk, yogurt, etc cheaper than high-fat. Problem solved……
  31. I am for reducing the number of governing agencies, which now are more than the number of hospitals.
  32.  Financial incentives beyond loan repayment for Doctors who enter primary care: PAY THEM MORE. A LOT MORE. Realize that preventing a patient’s heart disease is cheaper than his annual heart cath, and reward those who prevent it.
  33.  I strongly agree with “actual peer” juries that pre-hear malpractice testimony and scrap the crap.
  34.  Cut down on end-of-life critical care, somehow. Hold an honest discussion of our abilities with the country. We need to end the 3-week inpatient stays for uber-elderly demented people that we know will end in death anyway (I call this the $250,000 funeral). Part of this is make it illegal for medical TV shows to actually show doctors unrealistically saving lives (Think to every episode of ER ever, or half of the episodes of House, where quick shock of asystole means the patient happily strolls out the next day, or a genius doctor says: “Hey I looked at the spit on his spoon and noticed a skewed large spit bubble-to-small spit bubble ratio! I bet this is South African Naboshthian Hippoencephalitis! We just need to start him on IV Norweigan tree frog rectum immunoglobulin and he’ll stroll out of here tomorrow!”
  35. People need to know this isn’t Star Trek, we’re not miracle workers, and MRI machines and defibrillator paddles are not the fountain of youth.
  36.  Absolute and complete pricing transparency
  37. At least some share of cost for patients for every encounter/test/procedure/drug
  38. Resulting savings used to lower cost of insurance, broaden coverage
  39. Make the health insurance companies compete (across state lines, free market) like the car insurance companies do. Stop the frivolous law suits. How long have you been right about these things, Doug?
  40.  Make “The Tragedy of the Commons” required reading for ALL Americans who can read, and require them to write a 2 page essay regarding the meaning of the concept this item discusses. If a citizen cannot write a coherent essay after reading this item, then disqualify them from being able to vote.  To learn more about “The Tragedy of the Commons”, which reminds us that unrestricted access to a “free” resource will eventually kill it, see
  41. It is arguable that our nation is working toward institutionalizing a national belief in Santa Claus, which is to say that we can somehow become immortal, and all the good things in life can be obtained at little or no cost or pain (For instance, Mr. Obama recently said that he will work to be sure that Medicare beneficiaries aren’t asked to pay more for their care under health care reform!)
  42. No group of doctors makes more decisions that impact the health of the population than primary care doctors. Pay them better and hassle them less, to make this critical part of our profession more attractive to rational humans. (Full disclosure: I am an emergency physician)
  43. At their core, allegations of malpractice are scientific disputes. As such, they should be adjudicated by persons with sufficient training to make a defensible scientific adjudications.
  44. Until this step is taken, as defendants or potential defendants, those of us who are physicians, when confronted with an allegation of “malpractice”, will have to decide whether to fight or settle, mindful of the fact that if we fight, we will be deprived of a true jury of OUR peers.
  45. As rational doctors, we will continue to waste $$ on excessive and unnecessary tests and treatments until this tort reform step is taken. To allege otherwise is to chose to lie.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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12 Responses

  1. My comments relate primarily to pharmacy, but would have effects on other areas of healthcare:

    1. Get Tort Reform
    2. FTC needs to ban Direct-To-Consumer advertising
    3. Allow pharmacies accesss to General Services Administration (GSA) pricing.

  2. DefendUSA says:

    Portability…indeed. I had split enrollment once and it took me until my baby turned three to rectify a maternity issue that I was covered for, but no one seemed to understand the type of enrollment when the claim was processed.

  3. NE says:

    Our belief about life must be based in reality and must inform our practice. Physicians must come to support the sanctity of life from conception and stop treating fertility as a disease by providing their patients with cancer-causing and abortifacient agents and sterilization procedures. If we continue to do these things, we are as two-faced as any of the organizations now controlling medicine out of greed and the desire for power.
    Life is a sacred journey that begins at conception. We have been given the gift to heal people and restore their well-being. As physicians and nurses and others, we can be agents for peace. But peace on earth must begin in the womb.

  4. MajorStu says:

    1. Portability, once you qualify for health care coverage and establish an account, why do you need to get it from employers? Employers don’t provide car insurance. Employers could subsidize coverage in the interest of employee health and well-being, but portability and the ability to maintain coverage when moving to a different state would help.
    2. A standardized medical history questionnaire downloadable from the cloud – you go to a new health care provider, you get a 6 page questionnaire. Instead, they hand you an iPad, you enter your secure link it to your medical history form stored in the cloud, on-time download, 20 minutes per patient saved, no paper, and less chance for inaccuracy (did I have that surgery in ’83 or ’86, forgot about that broken wrist in ’74?) Always provide a response for recent health history, why they are presenting at this time.

  5. Tom Shubnell says:

    There are more commissions, committees, agencies, and groups that oversee medical care than there are hospitals in the US. I would eliminate the vast majority to save billions of dollars and increase the efficiency and efficacy of medicine.

  6. Tom Shubnell says:

    There are more commissions, committees, boards and agencies than there are hospitals in this country. Eliminating the vast majority would increase efficiency and efficacy. It would also save billions of dollars.

    Another thing I would do is allow insurance to be purchased across state lines to reduce costs.

  7. Ryan Ridenour says:

    Personal Responsibility (the longest four-letter-word in our society today). Would fix everything. If patients did the right thing for the right reasons they’d not have diabetes, obesity, etc; and would sue only if a real transgression appears too have occurred. If docs ALL did the right thing for the right reasons we’d be restored to our former position where patients trust us more and silly lawsuits/defensive medicine would fall off. If beauracrats and trial lawyers did the right thing for the right reasons….hmmm…now it’s seeming like less of a real world solution, isn’t it?

  8. Bobbi says:

    As a nurse for 20 years, I too am sick of the sick care that we healthcare professionals are suppose to dish out. My idea is to change the disease care system that we have to a truly “healthcare” system. Abolish all agencies that stand in the way of that. Let your imagination roam on that last one.
    When it is near illegal for a DR to give things like IV Vitamin C therapy, or any other nutrition based advice instead of some drug……we have a huge problem!
    It is far cheaper to keep people healthy than to treat them after they become sick.

  9. Debora says:

    On another note:

    Walk in Clinics should be available to Medicare/Medicaid patients. It is wasteful to deny them access (at a much cheaper fee) and force them to go to their local non-profit ER (already maxed out and much more costly to all of us).

    • Doug Farrago says:

      Agree to a certain extent. For very simple things it is okay. The fragmentation of care, however, is a mistake. Instead of a collaboration between NPs and doctors, the former has used these Walk in clinic as a way of competition. That does not make this relationship between the two any better.

  10. Bridget Reidy MD says:

    Pay us for our time, eliminating E and M guidelines. Include documentation time, another unrelated problem time, finding out the real med list time, counseling less than 50% of the visit (because the ones who need it most are the same ones who take more than 50% of the visit to get to the information we need),,,

    Why should a patient come in more to ask more questions or make us rush through them because it’s yet another free service? In what other profession is more than half of the service given not charged for? Who would go to a primary doctor and not expect some diagnosis, some ongoing management, some education, some rapor and trust generating small talk, some empathetic listening, and some prevention? Patients are generally reasonable. Not being paid to take care of them is not.

    • Richard W. Mondak says:

      Wholeheartedly concur!
      Practicing preventive medicine by Primary Care Providers and others who have a specialty field doesn’t seem to be valued by payors (or consumers) of health care. I’ve always thought that the most important aspect of our job is to try to make ourselves minimally necessary. I don’t forsee this ever happening, but I’ll still try…

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