First lets talk about what will NEVER happen. For those of you who have been brainwashed into certain fears we will never have a single payer system. Imagine how many jobs would be lost if Blue Cross/Blue Shield, Aetna, United, Cigna etc. were to all go out of business. Do you think the CEOs of these companies, making in excess of $100 million annually would be that willing to relinquish that kind of income?

If you think we have an economic problem now with lack of jobs; put those companies out of business and see what will happen.

Before we get into details let me first comment on my strong opinion is that the only chance we have to make healthcare reform worthwhile is for physicians that are currently working in the healthcare system from each and every discipline to form a committee that will provide direction.

Anything short of this will have a greater chance for failure.

Keeping in mind my previous thought that commercial insurance companies will never disappear, my idea would be to provide a “basic plan” of care that would be offered as the government option. In light of the fact that preventive care is the best care; providing “basic care” coverage would cover primary care, internal medicine, gynecology and pediatrics only. If a patient wanted to see a specialist, go to the ER or needed to be admitted to a hospital they would be fully responsible.

Supplemental coverage could be provided by private payers for a fee and would vary in scope and could include specialists, ER visits and/or hospital admissions. As incentive to join the government option, patients participating in the government option could be offered a discount for these non-covered services.

The next major issue that would need to be addressed is the reimbursement process. Currently Medicare/Medicaid reimbursement policies (and some insurance plans for that matter) are without a doubt nebulous if not at times seemingly purposefully convoluted. In an attempt to keep physician costs down it would be imperative that any plan would provide for rapid and accurate reimbursements.

Additionally, real time internet access to benefit information for ALL government run medical benefit programs would only make sense. I will divulge that as a primary care provider, the plan I have suggested would benefit me more than some of my colleagues.

In an attempt to remove any doubt that these ideas were not contrived with a self-serving motive I will contend that I am willing to accept a lesser fee per patient than I am currently accepting in order to make this plan work. I could only hope that my fellow primary care physicians would be willing to do the same.

There have been a number of irresponsible comments I have pulled from articles over the last few weeks. All can be attributed to “the experts” who happen to NOT be medical professionals.

The idea that we need “efforts to reduce waste by standardizing treatments and tying physician payments to the quality of care” is ridiculous. Consider the studies that indicate that there is a very high proportion of patients that are non-compliant with treatment.

How can you tie reimbursement to quality of care when there will be times when non-compliance effects the quality of care? You are also making the poor assumption that we do not already try to get patients to be as healthy as possible.

The idea of “standardizing treatments” is also silly. It can never be assumed that there is one “standard” treatment for each and every patient given a specific set of circumstances.

There has also been comments by those same non-medical “experts” saying that EMR prevent medical errors. Electronic medical records do not prevent errors. I REPEAT! ELECTRONIC MEDICAL RECORDS DO NOT PREVENT MEDICAL ERRORS. Diligent doctors, nurses and yes patients prevent medical errors. This is and continues to be a marketing tool that companies are using to try and push their products.

I have had an electronic medical record (EMR) system for five years. I love it and would not trade it. Besides saving space, making the office more efficient and saving on paper; the only other thing it has done is decrease the need for ancillary staff.

It is my staff, myself and my patients that have prevented medical errors. If EMRs are made mandatory it will be vital that vendors of such systems pass a very high minimum standard of service, knowledge and experience. I have fired four vendors in five years; all have provided less than stellar service.

Some have picked up and closed shop taking my technical support payments with them, some have installed upgrades and left it to me to troubleshoot the system.

Please understand, there is no plan that will be perfect. There is no plan that will satisfy all. Any effort to do so will only lead to waste and poor outcomes.

On a final note lets look to the future and see how my plan would help. Lets place the plan on a five year pilot program. Vital statistics could be recorded both at year one and year five. If these statistics show a significant difference in these vital statistics (proportional height vs. weight, blood pressure, fasting sugar levels, smoking, drinking and general level of physical fitness) then we can consider continuing the plan.

Perhaps the plan at that point can be refined? Perhaps at that point those patients can be offered a plan from a commercial insurance company at a reduced rate? Perhaps this patient could then qualify for a specific tax deduction which would help pay for the plan?

The options are limitless. The ultimate goal of my plan is simple. To increase awareness and expose patients to the information they will need in order to make well informed decisions that will effect their health both today and for years to come. This benefit will one day be manifested in a healthier elderly population which will invariably reduce Medicare costs.

This is distinctly different from the goals of the current proposed plans. It is my opinion that the current plan will simply ensure special interests are met and increase the chances of re-election of our state and federal representatives. I provide those representatives with a challenge. Prove me wrong, keep the plan simple. Use my idea.

Elmer F. Toro, M.D. specializes in family medicine and dermatology in Lehigh Acres.