HomePetro-addiction The Health Economy — The Alternative to Federal Government Shutdown
The Health Economy — The Alternative to Federal Government Shutdown
by David Cundiff, MD
01 March 2011
Editor's Note: the author's book The Health Economy was introduced to
Culture Change readers on Nov. 17, 2010, but it is now in a new e-book edition. The Health Economy concept's most prestigious endorsement was when Dr. George Lundberg, former chief editor of the Journal of the American Medical Association, recently linked to our previous review in his At Large column at MedPage Today. The following is the latest manifesto for the Health Economy. - JL
The Health Economy
will take the place of
today’s bankrupt Waste
Economy that has let
down working people.
The American people
are capable of
increasing individual
and public health,
prosperity, and
happiness. We can
replace institutionalized
waste and inefficiencies
in the public and
private sectors with
valuable economic
activities and
community building
pursuits that are not for
money. Volunteerism
and mutual aid can be
incentivized.
front cover art by Eddie Young
Jeffersonian democracy with cooperative community involvement is
what works, while the same old greed, corruption, and economic
disparities of our dysfunctional government and corporate systems
display failure more starkly each day. We can't afford the present level
of government spending and consumer debt, but we can definitely
afford health, helping others, and economic justice.
The Health Economy begins with patient-centered health care
reform. Reforming health care requires strengthening primary care
medicine and providing coordinated care rather than fragmented
treatments from unaffiliated providers. Republicans and Democrats
agree that better coordination of health care is necessary for a care
delivery system that gives universal access to treatment, high quality,
and affordability. Primary care physicians (PCPs) need to be in charge
to manage and organize care for patients within networks of specialist
providers working together.
The government’s choice for care coordination and increased
efficiency is “accountable care organizations” (ACOs). Like health
maintenance organizations (HMOs), ACOs shift the control of personal
health care treatment decisions from physicians and patients to
governmental and insurance company bureaucracies. Unfortunately,
top-down treatment guidelines may err by denying beneficial
treatments and approving worthless or harmful treatments.
Instead of ACOs operating under the thumb of government
regulators, the Health Economy plan proposes an alternative entity to
coordinate care -- “accountable care cooperatives” (ACCs). ACCs will be
constituted as nonprofit cooperatives owned by member-patients rather than
by investors and physicians.
The authority and accountability for determining what medical
tests and treatments are and are not covered by insurance will no longer
be controlled by government agencies or insurance companies. Health
care regulation will be decentralized and vested with the ACCs. ACC
physicians and their chosen consultants will control all medical
insurance spending for their patients (i.e., define the standard of care
with input from medical literature, published guidelines, medical
specialists, alternative healers, and patients). Self-regulating private
ACCs will compete with each other to provide the most appropriate
health services and best health outcomes.
With the Health Economy, businesses will no longer be responsible
for medical insurance of employees and their families. ACCs will receive
health insurance money for their patient populations consisting of
individual insurance premiums supplemented by “risk-adjusted”
allocations from the federal government to provide all health care
services. “Risk-adjusted” means the government prepays ACCs more
for older sicker patients than younger healthier patients.
To provide optimal care while controlling costs, health care
workers hired by and responsible to ACC enrollees will determine what
medical interventions will and will not be covered (i.e., define the
benefit package of insured health interventions). ACC physicians and
staff will not receive bonuses for limiting coverage of medical
interventions as the government proposes for ACOs. Savings from ACC
efficiencies will go to additional patient services and to reducing
patients’ insurance premiums.
The private health insurance industry will be retained and will
cover all 300+ million Americans that chose to join ACCs. The infamous
health insurance mandate of the beleaguered “Affordable Care Act” will
not exist. Insurers will not determine who to insure, what medical
interventions to cover, and how much to pay. Insurers will pay for
health care services following the dictates of ACCs.
Quality of life and longevity depend greatly on nutrition, income,
employment, race or ethnicity, quality of education, and where and
how people live -- the social determinants of health. In the Health
Economy, the government will continue to collect welfare funds, but
will then shift those funds to ACCs for more efficient allocation of social
safety net services. ACCs will fund and coordinate social services for the
homeless, abused or neglected children, substance abusers, seniors,
veterans, unemployed workers, and disabled people. Coordinated
mutual aid and volunteerism will supplement the professional services
provided.
Just as ACCs turn out to be just the right institutions to transform
health care and welfare, they can also fix other dysfunctional
components of government spending that generate a culture of
overregulation, waste, and dependence. In the $15 trillion U.S.
economy, about $2.3 trillion will be shifted from the government to the
new ACC sector. With both financial and people resources, ACC
member services will include creating jobs, fostering innovation and
excellence in education, promoting financial literacy and wise money
management, advocating for justice, caring for local communities, and
administering Social Security and public pensions.
The initial movement to embrace the Health Economy is more
likely to be led by ordinary informed citizens than by economists, policy
experts, pundits, and politicians. Once informed citizens see that ACC
“cooperative capitalism” can remedy government and corporate waste
and inefficiency, the leaders of the country will follow.
* * * * *
Take the Health Economy survey to contribute input for David Cundiff's campaign to launch the Health Economy. Participants get the e-book for free. Please go to
surveymonkey.com. The website for The Health Economy is http://thehealtheconomy.com/
David K. Cundiff, MD is the author of previous books such as The Right Medicine: How to Make Health Care Reform Work Today, co-written with Mary Ellen McCarthy, Humana Press (1994), and Money Driven Medicine – Tests and Treatments That Don’t Work, by David Cundiff, MD, published by Cundiff (2006). He was employed in the 1990s at Los Angeles County - USC Medical Center Hospital in oncology and internal medicine for hospice patients. David's work quantifying the astronomical health and financial cost of car dependence and use of fossil fuels appeared in the Auto-Free Times magazine (now CultureChange.org) in the mid-1990s.
Culture Change's Jan Lundberg has been serving as editor of David Cundiff's book The Health Economy.
Culture Change mailing address: P.O. Box 3387, Santa Cruz, California, 95063, USA, Telephone 1-215-243-3144 (and fax). Culture Change was founded by Sustainable Energy Institute (formerly Fossil Fuels Policy Action), a nonprofit organization.
Some articles are published under Title 17 U.S.C. Section 107. See Fair Use Notice for more information.