I am generally in favor of a free market economy, so much so that I’d like to eliminate collective bargaining. However, I don’t believe a free market system is appropriate for health care. I prefer a government-run system financed entirely by taxes. 

One reason is that in a market system, the supplier’s main goal is to make money. Faced in any situation where there is a choice between doing the best thing for the patient and maximizing profit, the provider will choose the latter. We can live with that in other areas of the economy because the customer can shop around. If he doesn’t like the deal he is getting, he can go elsewhere, or he can delay the purchase, or he can find an alternative solution such as renting instead of buying. That is not the case with health care. Often, the “customer” is sick or injured and in no condition to go shopping. Even if there is someone to search on the patient’s behalf for the best medical care, they may not have time to do so. Often, medical care delayed is medical care denied. 

One way to implement the system would be to extend Medicare to all citizens, financing the entire system with an income tax surcharge. Robert Samuelson, an economist who writes a column for Newsweek, suggests a dedicated health system tax that makes it clear to citizens what the system is costing them. Samuelson considers the rising cost of health care a more serious issue than the fact that a lot of people are without health insurance.

To reduce costs, we should begin moving as rapidly as possible toward direct provision of services by non-union Health System employees at Health System facilities, replacing the current system in which private providers bill Medicare. Our veteran's hospitals are a current example of government facilities staffed by government employees. We could start by taking over failing hospitals in the inner cities, making sure that the neediest of our citizens have access to health care. We should also quickly take over the functions that are most susceptible to fraud. It is estimated that up to 10 percent of Medicare's current budget is lost to fraud.

Another early step should be the design of an ideal community health care delivery system or "unit", a collection of facilities capable of providing all the health services required by a community defined by some combination of population size and geographic area. Once this health care unit is designed, a model should be put together in a real community to see if it works. The successful health system unit would then be duplicated throughout the nation.

Benefits to the Patient: 

• Medical records would be kept on a national database, instantly available for treating a patient regardless of his location. The database would also make it possible to contact the physician and/or patient when a new treatment of a condition becomes available.
   
• The most current information on diseases and standard treatment would be instantly available to anyone in the system. Notification of critical new information could be instantly distributed to all concerned personnel.
   
• When the goal of a system is not generating revenue, but providing the best care at the lowest cost, other efficiencies are possible:
   
  • Fewer office visits would be needed because a medical help line would be available for people to call for advice. Some problems may not require treatment at all. Others may be treated simply by ordering a prescription, or suggesting other self-administered treatment. When hands-on treatment is necessary, the Help line would direct the patient to the nearest qualified facility, or the qualified facility where the patient is likely to be seen soonest.
     
  • A greater emphasis would be placed on preventive medicine.
     
• One agency in the System will have the mission of finding and testing new treatments and procedures. Once the best treatment has been determined, it will be published on a national network to which everyone has access. Once a condition is diagnosed, the physician will be able to look it up and find the best treatment.

Benefits to Business: 

• Business costs would be reduced because they would have none of the expenses related to providing health insurance for employees and retirees.
   
• Workforce mobility would increase when employees no longer hold on to a job just because of its health insurance program. Workforce mobility increases productivity because employees move to the job for which they are best suited.
   
• Because employers will no longer be concerned about employee health care costs, they will be less fearful of hiring people with health problems. For the same reason, confidentiality of medical records will be less of an issue.
   
• Universal access to health care should reduce the number of workdays missed due to illness.
   
• Evening hours for health care will reduce the need for employees to take off work for doctor appointments.

Benefits to the Economy in General: 

• A single health care system will be less expensive just because one system is less costly to administer than multiple systems. The health insurance industry would disappear.
   
• Physicians would no longer have to purchase malpractice insurance. The system would discipline bad doctors and provide for compensation of patients harmed by the system.
   
• A National Health Care System would be paid for out of the General Fund, which will be supplied primarily from the income tax. Shifting to this National Health Care System will require a big increase in taxes, of course, but due to the efficiencies of the new system, the total cost will go down. Our taxes will go up, but we will be better off because we are no longer paying for health insurance and we are paying less for goods and services due to the fact that businesses are no longer paying for health insurance for their employees.
   
• To the extent possible, physicians and other medical and administrative staff will be government employees. No unions will be allowed. Staff will be paid the lowest wage/salary required to attract qualified people.