Insurance companies are impersonal institutions that are much more motivated by the bottom line than by the health needs of the people they serve. It would be great to disassociate our health care from big companies, and turn it’s management over to patients and medical personnel. Our nation’s health, like it’s education should not be a profit-motivated enterprise.

Health care centers might be located in low cost, very accessible non-medical facilities, such as apartment building complexes, churches, schools, and community centers, as well as in hospitals. Dentistry, ophthalmology, optometry, physical rehabilitation, mental health counseling, and most prescription drugs might also be available as part of the NHC program.

The cost of acquiring and using large testing and treatment equipment and laboratory services might be shared by clusters of NHC centers, and paid for centrally. Similarly, all patient history, treatment, test results, and other relevant information would be centrally coordinated and easily available to each center, as needed. Participation in the proposed centers program will be optional, with eligibility beginning at birth. Diagnosis and treatment will be determined by patient-selected primary care physicians, who would then supervise all the paraprofessional staff that work with their patients. They would also perform all complex procedures, and consult with the paraprofessional teams about their patients, as often as necessary. Volunteer experts will oversee administrative efficiency.

Delivery of excellent universal health care is a public responsibility that’s too expensive and too complicated to be shouldered by individuals, employers, or government alone. Also it’s too vital to depend primarily on profit for its motivation. It’s very important that health care providers be motivated also by personal relationships with their patients.

Medically supervised paraprofessionals will work as physician and nurse practitioner assistants, handling many patient needs at much lower cost. A team of paraprofessionals will serve every patient, with each trained to relate in depth to one or more specific types of health problems. At least one member of the team will always be available for patients to call on, whenever they want help. Others will be accessible, if they’re needed. Paraprofessionals involved with diagnosis and treatment will always work with M.D. supervision and consultation. Some paraprofessionals might become patient advocates who serve as liaisons that keep medical staff in touch with patient needs.

Many paraprofessionals might also learn to facilitate discussion groups, in which patients share experiences and support each other, while misinformation is corrected, fears are quieted, pain and anxiety medications are administered with M.D. approval, and all questions will get informed answers. These group programs will also offer ongoing disease prevention and treatment and a range of activities that include nutrition information, exercise, meditation, relaxation procedures, and general health education.

NHC programs are mainly intended to relieve middle class families of the enormous health care burdens they carry. Medicaid and clinics are available to the very poor, and obviously the very rich can personally pay for whatever insurance or other costs they incur. NHC center programs propose to provide all health and hospital services at no cost for families earning under $150,000 per year, or individuals earning under $100,000 a year. Patients with incomes over these amounts will pay some percentage of their costs. Those earning over $250,000 per year would pay all their NHC program expenses. However, the cost of NHC medical services should be much lower for everyone than the average premiums for adequate private health insurance.

Both the central and local publicity and fundraising activities of the NHC program will be as extensive as possible. Everyone employed in or served by the centers, as well as their friends and families, will be urged to participate in collective fundraising efforts, at least to some extent. Many small donation campaigns, like the original March of Dimes for polio, will be organized and possible foundation grants and private charities will be explored. Celebrities will be recruited to sponsor fundraising entertainments and other events. Many interested non-profit groups will also be asked to participate.

T.V., radio, and news media will be asked to donate expanded public service time and space to publicize and present these events, as well as other NHC program activities. It will be important for the centers to become as well known as possible. Perhaps, some center participants will join activist organizations that lobby for legislation to get funding appropriated for these efforts. In addition, tax advantages might be designed to encourage individuals or corporations to contribute money and time to NHC programs that interest them. Some government bond issues will pay for specific health services. Graduated income taxes on individual earnings and on corporate profits of over $1 million a year can be earmarked to cover most of the remaining costs.

Universities and other training institutions will be urged to make many more medical and paraprofessional training programs, and need-based scholarships and grants for living expenses available to all qualified applicants at low or no cost. In some cases, NHC program might lend some applicants the money to pay for their training. If they agree to work at a neighborhood center after they graduate, some portion of their salary could be deducted to repay these loans. Training many more doctors for diagnosis, treatment, and supervision will lower waiting time for necessary therapeutic intervention and prevent many medical problems from ever developing. More trained paraprofessional practitioners would greatly increase time for one to one patient relationship, information, and care, while lowering the total cost of treatment staff.

Medical costs overall will be lowered and quality increased, because huge profits enjoyed by private insurance will be largely eliminated. Any non-medical determination of which treatments are appropriate will be eliminated. As a result of creating a situation in which only medical staff makes treatment decisions, many people will live who might have died for lack of necessary procedures that insurance companies were unwilling to pay for. Huge savings on overpriced therapeutic drugs will eventually derive from lobbying legislators to lift restrictions on their purchase abroad, and instituting more careful inspection of foreign drug production and product quality.

Prices for prescription drugs should, if possible, be based on their cost, and excessive pharmaceutical expenditures should be government regulated accordingly. Product research might be paid for in the ways indicated above and conducted in some of the centers, as part of their program. Federal and state research grants should be sought to help produce unbiased information about health treatment, prevention of disease, therapeutic drugs, and other medical matters.

Possibly most importantly for many people, NHC centers will provide social and community experience that relieves feelings of isolation and promotes recovery. The centers will attempt to facilitate a return to small-town family medicine, in which staff and patients are very familiar with each other and empathize, care, and help whenever they can. The groups conducted in the centers will further help to personalize health care and facilitate personal relationships in which sharing and support will be available.

Overall, less time, material, and money will be wasted because everybody will be encouraged to develop a stake in generating the financial support of each center, of the overall program, and of each patient. If the purpose of all aspects of medical practice was healing and no profit motive was involved at all, all medical costs could probably be drastically cut, without loss of quality of health care services and possibly with improvement of them. Patients and students, as well as administrative and medical staff working together as a health oriented community could accomplish many things, only a few of which have been touched on here.

If you’re interested in developing such centers as a medical delivery system in your area, indicate so in your comments and I will put you in touch with others who want to be involved.