HEALTH CARE SYSTEMS REFORM: It’s the Financing, Stupid!

Thomas Billroth Gottlieb, MD

Physicians, health care providers, and citizens/residents want high quality health care at reasonable cost resulting in healthy communities.  Education and research surrounding these democratic values of quality, cost, and healthy communities have been opposed by corporate stake holders of the medical industrial complex.  These values are not being met in the US.  Due to failure to achieve these goals, the US health care system has become a troubled asset in need of a Troubled Asset Relief Program (TARP).  

In 2008 the US government allowed the Treasury Department to purchase or insure the toxic assets of failing bank investment programs, credit markets, housing, and the auto industries.  The US Treasury Department established several programs under TARP to help stabilize the financial system, restart economic growth, and prevent avoidable disasters.  For example, the auto industry (GM, Chrysler, and Ally) received a loan of $80 billion dollars through acquisition of stock by the US and Canadian governments, all of which was repaid with a return on investment (ROI) measured at seven years.  The health insurance market is now a troubled and toxic asset in need of support to stabilize our financial system, restart economic growth, and prevent avoidable future disasters.


US Health care costs are $10,345 per person for total US expenditures of $3.2 T per year.  This is twice the average cost of other OECD (Organisation of Economic Co-operation and Development) countries, each of which produce higher quality, equitable health care services to the entire population.  Much speculation of high US cost implies that patients are too demanding or that physicians/providers are delivering unnecessary health care services.  We don’t need more demonstration projects [such as P4P (Pay for Performance), ACO’s (Accountable Care Organizations), Bundled Payments, and more], none of which have solved the cost/quality problem.  Millions of US residents suffer because they cannot access needed care or pay the costs, and are pushed into poverty. A solution directed at the financing of health care services is needed.


This is not “rocket surgery”.  Key to a sustainable quality health care access model for everyone without financial risk is a less fragmented, public-sector, single-risk-pool/single insurance financing model.  Improvement in health care delivery is more effective and sustainable when linked to broader public sector reforms.  A major component includes compulsory and less-fragmented pooling in insurance.  Commercial insurance enterprises in a “free market” manages risk by avoiding sick (pre-existing conditions) and indigent individuals resulting in price discrimination.  This unethical practice is solved by utilizing a single risk pool for all citizens and residents.  We propose that the most effective method is utilizing a consolidation strategy, and since the US government already provides over 60% of health care funding in the US, that only a public national consolidation strategy is feasible.


The Center for the Study of a Public National Health Insurance (PNHI) has proposed a business plan boilerplate that defines a financing tactic that drives equitable health care.  This proposal recognizes that a free market for health insurance has failed, that consolidation of health insurance requires that commercial insurance products are acquired at enterprise value, that only a national public entity can accomplish this acquisition, and that the delivery system remain as a private entity.  This defines a program of socialized insurance, not socialized medicine. 


For the business plan white paper, go to Health Care for All Colorado Foundation (HCACF), The Center for the study of a Public National Health Insurance (PNHI) at


Thomas Billroth Gottlieb, MD
Health Care for All Colorado Foundation
The Center for the Study of a Public National Health Insurance (PNHI)
789 Sherman Street
Denver, CO  80203

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