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How to fix US health care

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US health care costs 17% of GDP, a staggering $3.2 trillion or $10k per year per person. Costs are twice as much as those of other developed nations and the results are worse, Americans live 4% less, and are in worse health than citizens of other OECD countries. Health care is unevenly distributed, many have no access or poor access to it and it is extremely expensive and unpredictable. My 3 year old fell in the bath tub in Los Altos Hills, California, he needed 9 stitches, a simple procedure, but our wait was four hours and our bill at the Stanford Hospital emergency room turned out to be $15,900 of which $3k we had to pay ourselves and the rest was paid for by Cigna. While on vacation in Paris 6 years ago I had a similar injury. Went to the emergency room near Place des Vosges and my wait was 45 minutes and my cost was $0, if I done the stitches with a local plastic surgeon the cost would have been around €600. Given this situation and the fact that I now run Prelude Fertility a US health care company, I decided to write an open sourced article. What I mean by this is that I will throw my list of ideas on how to fix the US health care system and you tell me if you agree, if you disagree or if you think that more ideas should be added. Here they are:

-as opposed to other countries the USA has a bloated administrative layer over the health care system which are the health care insurance companies. This layer results in 30% of the costs which could be greatly reduced if providers were also insurers. We have to find a way that either providers become insurers or health insurance companies become providers.

-we need to double the number of MDs in the USA to the levels per 100k citizens that are common in other developed countries. USA has too few by international standards. For this we need shorten the medical career to the duration of other countries and make becoming a doctor tuition free. Pick great candidates and finance them. Because otherwise it is understandable that if it is so expensive to become a doctor, MDs have to earn extraordinary salaries to pay back their student debt.

-we need to reduce the profits of lawyers from medicine, we should not allow anyone to sue for malpractice for an award higher than $300k. The concept that doctors should pay for their mistakes has to be limited because no doctor ever wants to harm a patient. In other countries you can sue doctors but awards are limited. I don't see anyone asking MBAs or economists to pay for their mistakes and those have almost destroyed the US economy. Doctors are held to an unreasonable standard by the US legal system.

-we need to allow the US government to negotiate the cost of medication with drug companies. USA is the only country in which drug companies have lobbied for this to be illegal and that alone could save billions to US taxpayers. Medication in the USA costs around double of what it costs in Europe or Asia. USA needs the equivalent to the European Medicines Agency.

-we can extend the VA health care system to cover the basic medical needs of the general population. Just like USA has public schools and private schools it should have a public health system that provides basic health care to all and then those who can afford it can buy more expensive health care just like those who can send their children to private schools, but make health care available to all. Most countries have this system, basic for all and private for more convenience, shorter waits, etc.

-we should require the testing of embryos in IVFs or pregnant women (NIPT and amnios) in order to reduce the number of children born with congenital illness. The best way to lower health care costs is for people not to get sick and preventing severe illness helps parents and the health care system as a whole. This is more and more commonly done but not as widely as needed.

-we should reward people who make healthy choices in life. People who lose weight or people who quit smoking, people who practice sports should pay less for health care.

-we should require that people do annual medical examinations including full blood work, blood pressure and anything that can be tested in 30 minutes. Preventing illness is much easier and inexpensive than curing it. Blood work costs are plummeting and more and more can be detected.

-Congress designed the FDA with a major flaw. It is not mandated to cure illness but only to make sure medication will do no harm. Result is that each drug approval costs billions. Change the mandate to include both safety and healing and more drugs will be approved. The lowest hanging fruit here is to combine genomics with drug approval or pharmacogenetics. If we would approve drugs depending on people´s genomes we could approve drugs that are effective only for subsets of populations. Many drugs just don't work on everyone due to our genetic differences.

-allow patients to decide in a much simpler way not to take life prolonging medical treatment since most health care costs are on the last days of a person's life.

What else can you think that the US could do to have health care costs cut by 50% in the next two decades and fall to the level of other nations?