Since I dislike the tactic of people who complain without offering concrete counter-proposals, I will present one here. Here is a very rough outline of an alternative:
- All physicians are owner-operators of their own business. They are not employees of any sort, of either a corporation or of a government agency. They are not contractors, but rather control their own practice. They set their own hours, conditions of work, and list of patients.
- All physicians have the right and the duty to join a local medical association. The local associations are free from external interference, and make up their own rules governing their members. Each physician-member has an equal vote in the association.
- These associations contract with the local government regarding community health care, with government and the associations being on equal footing in the negotiations. This contract covers all matters that are not those between patient and physician, such as immunization programs, disaster assistance, and health care of the indigent.
- Government has a duty to recognize the association and accept its members, and also has the right to set certain expectations for all the associations for the common good.
- The level of government ought to be as low as possible, for example, city government for the big cities, or counties in most other places. Contracts made at a lower level override contracts made at a higher level — the opposite of what we find typically.
- High-level associations — such as state-wide or national — will have the right to authoritatively propose policies, but local associations will have the right to implement these policies as they see fit, if at all.
- Every person living in a given area has the right to health care in that area, whether or not they are citizens, even if they have low quality of life or so-called Lebensunwertes Leben.
- Health care is provided according to a sliding scale of price. The rich pay more than the poor. This may be implemented in whatever way the local association and local government deems acceptable. Certainly this is best implemented by way of externals unrelated to health care, such as posh waiting rooms for the wealthy. First class accommodations serve the purpose of subsidizing the poorest ones.
- Every patient pays what they can, even if they can only pay a few dollars for a service, or even barter.
- You have to pay your dues. A physician cannot just open a cosmetic plastic surgery practice, but rather must first work his way to the top doing menial, unwanted jobs. This is an essential part of the system, and desirable practices are rewards for doing the unpleasant jobs first. For example, a young physician may have the duty to care for the indigent at low pay; but doing this for a certain number of years, he will have the right to a cushy practice — but not without first having paid his dues.
- Some cities may be quite wealthy, and others poor. Agreements between local associations will allow new physicians to 'pay their dues' in the poor areas before getting the comfortable practice in the wealthy area.
- Hospitals are independently operated as non-profit charities, in coordination with local governments and local physician associations. Local hospitals cooperate with each other to avoid expensive overlapping services, and cooperate with the government to provide adequate emergency services in case of natural disaster or epidemics.
- Insurance is handled locally by the physician associations, and ought to have very low overhead. Insurance for travelers ought to be organized via contracts between associations.
- Any complaints against a particular physician ought of course be first taken to the physician by the patient himself, and if satisfaction is not found, to the local medical association. Associations ought to have great flexibility in reassigning or punishing a member: even though a physician may be a poor surgeon, perhaps he might make an excellent pathologist. Only after running through the local association can the matter be taken to then courts, and even then local courts are best at serving local conditions. Punitive lawsuits tend to only make lawyers wealthy, as well as impose greater costs on everyone else. However, this ought not to mean that government cannot impose punishment on wrong-doing: rather, more gentle and inexpensive local solutions are often best.
- Nurses and other medical professionals ought to be organized along similar lines.
- Each profession is kept distinct, with their own customs, and areas of interest. Each profession ought to have a unique mode of dress appropriate to, as well as unambiguously identifying their profession. Dress also ought to be indicative of rank.
- All this is done for the good health of individual patients, while providing a decent living for medical workers.
Libertarians or socialists will not like this system, but I think this is closer to a Catholic view of the matter. If you don't like the system, you know who to complain to — your own personal physician and local politician. Decisions are made by these individuals and not by some far-off bureaucrat, and so in this way it is far more democratic and more free than the alternatives.
Also, this ought to be low-cost. Large medical corporations often spend half their income on mergers and acquisitions, and of course government tends to be greedy for tax revenue, as well as lackluster in providing services. I think that this is not a compromise between current philosophies, but rather is a true alternative, one which trusts individuals within a framework of checks and balances. It is also more practical and loving.