Improving U.S. Healthcare:16 Changes I would Make

September 27, 2014

If someone gave me a magic wand and asked me to change the landscape of the U.S. healthcare system here's what I would do.

When I interview candidates for a position in my practice, one of the questions I like to ask is, “If you had a magic wand and you could have any job in the world, what would it be?” The responses are interesting and informative, and they help me determine the candidate’s professional goals, personal ambitions, and personality.

There is no correct answer, but responses I am NOT looking for include: “I would like to be a toll collector on the midnight shift at New York City’s George Washington Bridge,” or, “I want to progress from my weekend hobby of hacking computers to full-time employment.”

If I was interviewing for a position at a health policy organization, such as The Robert Wood Johnson Foundation, and I was asked a similar question - "If you had a magic wand and could alter healthcare’s 'current landscape' what would you change?" - here's what I would say:

1. Doctors would get compensated for keeping individuals healthy and out of hospitals.
2. Individuals would be rewarded for drinking water at lunch as opposed to soda, jogging as opposed to watching TV, and eating fruits and vegetables as opposed to candy and chips.
3. Candy and chips would cost individuals much more than fruits and vegetables.
4. Fast food restaurants would charge more for an unhealthy meal than a healthy meal.
5. Pharmaceutical companies would get compensated for discovering reasonably priced drugs, not for drugs that cost $1,000 per injection, per day, that “may” extend someone's life an extra three months.
6. Doctors and hospitals would get compensated for encouraging terminal patients to “die with dignity” and comfort during the last three months of their life.
7. Device manufacturers wouldn't deliver products that carry a 500 percent markup.
8. Hospitals wouldn't charge for a device that carries a 1,000 percent markup
9. Hospitals in New York City, Chicago, and Los Angeles would charge the same amount for the same operation.
10. Physicians in Bucksport, Maine, Daybreak, Utah, and Yazoo City, Miss., would charge the same amount for the same visit.
11. Medicare, Medicaid, the Blues, third-party payers, and self-pay patients would all pay the same for the same operation or visit.
12. Insurance companies would no longer deny converge and impose $10,000 deductibles.
13. Individuals would pay a reasonable fee for a medical service with no deductibles and copayments.
14. Emergency rooms would treat true emergencies, not sore throats.
15. Doctors would do house calls to treat sore throats.
16. Doctors would get compensated the same amount for a Web-based patient visit as an onsite office visit or a house call to treat sore throats.

Upon providing this answer, my potential employer might determine my professional goals, personal ambitions, and personality are irrational, unrealistic and sophomoric. They may also offer me a job.

What changes would you make to the U.S. healthcare system if you had the opportunity?