A Surgeon's Radical Proposal for Universal Health Care

Michigan surgeon James Rice, MD, has developed a universal healthcare system model that he says would encourage responsible patient utilization and force providers to compete based on quality and price.

Dr. Rice's proposed model would create a central system that individuals would pay into through flat income and sales taxes, which would be held in state or regional health funds. Patients would have control over their own electronic healthcare accounts, with each individual's budget based on medical history and existing conditions, says Dr. Rice, a general surgeon at Muskegon (Mich.) Surgical Associates. For example, a healthy young adult would be allotted about $500,000 for their lifetime, he says.

"There are 2 major differences in this proposed plan. One is that patients would authorize the transfer of funds from their healthcare accounts online, and the other significant change is that doctors and facilities would be competing based on price and quality," says Dr. Rice. "Right now, we're under a price control system, which is called administrative pricing. And the government or the insurance company authorizes the transfer of funds. In this new system, the individual owner of the account directs the funds. And if they spend wisely, they receive a bonus."

For example, a patient would receive a bonus for comparison-shopping for non-emergency care, which would in turn create competition and lower prices among doctors and hospitals, says Dr. Rice. Conversely, individuals would be penalized for avoiding evidence-based preventative procedures like colonoscopies and mammograms, "in that they wouldn't receive a bonus," he says.

In Dr. Rice's system, state or regional healthcare boards would make fiscal, administrative and quality assurance decisions, determining what procedures would be covered and ensuring that doctors' and hospitals' prices are fair. Plan participants would elect board trustees - local medical providers, citizens and businesspeople, for example, he says.

Dr. Rice hopes to trial the system at 10 U.S. sites, where the models would be evaluated for effectiveness and modified as necessary. There is not yet a timetable for doing so, he says.

Mark McGraw