Proposed here is a relatively simple plan that conservative and moderate Republicans, main stream Democrats as well as Independents could all rally around.  It is a plan that would  tackle the health care crisis in America in a responsible and affordable manner.  This plan gives coverage to all citizens, reduces overall national medical expenditures from current levels, and keeps our free market health care system intact.  

Last year I took a homeless man to the emergency room because he had bronchitis with a persistent cough. The emergency room doctor prescribed antibiotics and three times a day breathing treatments. Although he didn’t seem that bad off, he was admitted to the hospital for treatment and follow up. I didn't see the final bill, but it was surly many, many thousands of dollars for the seven or eight days he remained in the hospital. 
 
Now, here's a solution to our health care problem. A three tier system of health care:

Tier 1.  (no frills) Through financial and other incentives, encourage each hospital to establish a free clinic. You can see many examples of efficiently run free clinics throughout the country (around 1,200 at the current time). The best of these along with information gained from years of county health department operations could be used to establish a system that would cover all Americans with at least a (no frills), national health care plan.  In addition to government funding, pharmaceutical company cooperation, private sector funding and the encouragement of at least some volunteer staffing, a sliding scale from $0 to Low $ could be used to offset some of the cost.
 
Tier 2.  (low frills) Initiate a lower cost, (low frills) privately run HMO type option that no one could be denied access to, even those with pre-existing conditions. It could be government subsidized, but would still be primarily paid for by the individuals and families that have a need for this lower cost insurance option.

My in-laws are on Medicare and are members of an outstanding HMO in Miami. They love it and actually prefer it over their previous PPO coverage. There are many of these great and efficient HMO’s throughout the country that could be used as models for establishing this lower cost, (low frills), non discriminating national health care solution.
 
Tier 3.  (high frills) For those happy with what they now have, leave them alone. They or their employers are paying for Cadillac insurance coverage so they deserve (high frills) Cadillac treatment.  The World Health Organization (WHO) has ranked the United States as #1 in health care of all 192 nations.  It is this free market aspect of our health care system that has made us #1 in the world.  Why detract from that fact, or penalize our free market health care system for doing the amazing job that it does.
 
I know this is an oversimplification, but it is at least a starting place for providing health care for all Americans, and with an affordable price tag. 
 
In the example of the homeless man with bronchitis above, he could have been prescribed the antibiotics at a free clinic and allowed to come in three times a day for his breathing treatment, which would be administered by a tech.  The doctor, PA or nurse practitioner could have seen him at the completion of treatment to make sure the treatment had worked.  If the doctor at the free clinic saw an emergency situation that he or she was not comfortable handling, the hospital ER would still be there to serve the patient with a severe emergency. In the case of the homeless man, the cost through the free clinic treatment would have been, at most, 5% of the in-patient hospital treatment.  Multiply this by tens of thousands of emergency room visits by the uninsured with ear aches, sore throats, etc. per day. The savings through these free clinics would be in the billions.  These savings could be funneled back into a Republican comprehensive health care plan.
 
Big limits on malpractice liability for all three tiers would also need to be implemented.   With mal practice liability greatly reduced, doctors fees would also naturally come down.  Concerning the few who are involved in extreme price gouging and fraud, appropriate consequences should be felt.  Doctors are professionals and as a rule have the patients best interest in mind. They should not be expected to provide every test known to man just to make sure they cover their back sides and don’t get sued for malpractice because they missed a diagnosis that is 99.9% unlikely in the first place.  Since all Americans would have at least some degree of medical advocacy, prescription meds would cost the same for everyone.
Insurance companies are currently regulated, so it is simply a matter of refining and tightening those regulations in areas where they are found to be unfairly taking advantage of people.   So, while reform may be necessary in some areas, the system isn’t so broken that reform is impossible in the free market system we now have.
 
 
Also, while we are looking for solutions to problems, it is unnecessary for there to be hungry people in America today.
 
With the increasing economic burden of providing for over 34,400,000 food stamp recipients (that’s one in nine Americans) and with the number growing daily and resources diminishing, this program may one day need to be modified.  We have all seen and heard examples of how extravagantly some recipients use their food stamps.  In the meantime there are hundreds of thousands homeless and others that fall through the cracks not served by food stamps, but are none the less hungry Americans.  For these, a supplemental program, costing a fraction of the food stamp program should be implemented.  The only qualification for this program would simply be a willingness to stand in line for an hour a week to get $10 or so worth of surplus or bare essential food such as rice, beans, cheese, peanut butter, powdered milk, day old bread etc.  Free is free, deals with a real problem, and is surly a whole lot better than the nothing they now have. Even a druggie mother who feels bad that her children have nothing in the house to eat could simply go down to a distribution point, stand in line for an hour and get a bag of free food to feed her hungry children. This type of bare bones help is relatively inexpensive, something the country can afford and solves a bigger problem than many of us like to think exists.  Having been involved in the social service field I have some personal knowledge of the seriousness of this problem.  Also, it’s bare bones nature would encourage people to find whatever work they could in order to improve their standard of living. 
 
Of course, anyone severely handicapped or in a crisis situation would still be evaluated and aided in additional ways by other agencies, as is currently the case. 
 
Sincerely,
 
Tom Garito
 
P.S.  I just got an e-mail concerning a friend in Canada who bumped his head in a bad fall and as a result has bleeding on the brain and double vision. Because Canada has national healthcare and his condition is serious, they admitted him to the hospital. The down side is that since they are so underfunded he will not be able to get the doctor prescribed MRI that he needs for two weeks. The nurse told him that he was lucky though, as a doctor prescribed MRI for those not admitted to a hospital, is about one year. So much for full-fledged Canadian type National Healthcare.