Solutions to some of our Health Care problems

How to meet at least some of our health care challenges

There are multiple shortcomings in our health system today. These have been widely discussed, so I will only outline what I see as the key problems below, before moving onto a solution.

1. Our Health care system is too expensive.

Americans pay substantially more for health care than do citizens of nearly every other country.

The current insurance system has distorted the market so that simple medical procedures can bankrupt uninsured or underinsured families.

American businesses are put at a competitive disadvantage in world markets as U.S. companies pay substantial health care premiums, while competing companies in other countries do not directly pay for employee healthcare.

Within the insurance cost matrix, individuals and small businesses pay disproportionately high healthcare insurance costs compared to corporate or government employees; this discourages the grass roots of the economy.


2. Our health care system fails to provide a safety net, and this costs us more while providing us less.

People with inadequate insurance forego routine and preventive care. Routine & preventive care are the most cost effective parts of health services and do the most to improve quality of life.

Emergency rooms across the country have been forced to become more than emergency rooms. We have long wait times in overcrowded rooms filled with uninsured patients, who often cannot pay, needing routine care, or care that would have been routine if care had been sought in a timely manner. This puts at risk insured patients who need emergency services. The emergency room has become an expensive doctor’s office, funded by inflating costs for insurance and for those who pay for service.

Costs are out of control for anyone trying to pay out of pocket.

3. Our health care system is inefficient. There are many options for keeping people healthy, and often less expensive alternative treatments are not supported by the system.

4. We are not going to have enough doctors, nurses, nurses aides or medical tech people to take care of us baby boomers as we age.

Medical School is too expensive for most to contemplate. Our colleges, lacking spaces, turn away qualified applicants to nursing schools. The prospect of large debts affect the choice to go into medicine and health as careers. Debts influence what parts of medicine new doctors pursue. More health practitioners at every level will be needed in the coming years. We need to encourage health and medicine as career choices.
We could keep going with the problem, but let us now look at a 2 part solution.

PART 1. A new approach to training health care professionals - from nurses aides to specialist doctors. Create an alternative to the existing system we have created to train new health care workers.

Institute a one year for one year tradeoff to gain medical training. On completion of a year of free schooling, the health care student would spend a year working in a clinic or hospital for a only a living stipend.

Year 1 of training would include basic first aid & sanitation and the basics of working in health care. It may include self care and child, family or elder care. On completion of the “year 1” classes, the recipient is awarded a certificate. To continue, onto “year 2”, the student would be obligated to work for a one year in a clinic, nursing home or other private health care facility for only a stipend.

At the completion of that one year of service, a second year of medical education would be offered, again entirely free of charge. Again, the “year 2” graduate would be obligated to repay the training by working for a year. This continues with a year by year exchange of service for education.

People who might contemplate a career in healthcare would have a path that guarantees a survival stipend, and leaves open the choice about how far to pursue training. A completion certificate is offered at each level. No completed year is a waste. At any time, there is no more than one year of commitment to the clinics, after which one can enter the private sector, with both education and on the ground experience, and without debt. One might stop with a year 2 certificate, or perhaps carry on through a year 6 certificate. Each would have value in gaining health care employment.

Early years training could be provided at the Community Colleges. Later year’s training would probably be based at universities and medical schools or possibly hospitals.

A doctor who went through this system might have spent 20 years of time, have 10 years of experience, and no debt, when ready to enter private practice.
The traditional route to an M.D. would remain open. These two routes of training would converge at the door to the licensing exams.



PART 2. Clinics – open to everyone, staffed by students and graduates of the school-for-service program. These clinics would provide preventative, routine, and some limited emergency care and be available to everyone. These clinics would, under physician / pharmacist supervision, be able to offer generic and low cost prescription medicine free of charge for those unable to pay.

These clinics could be operated by local governments or schools, by hospitals, or by private health care providers contracting to serve an area or population. It would be necessary to create mobile clinics (converted school busses?) to serve isolated or under-served areas.


We can do all of this without decreasing the health care options of insured people.

This plan would not replace private insurance or private doctors or hospitals. The clinics would not be obligated to provide long term care or expensive therapies. If you go to the clinic, there would probably not be a choice of doctors. You might be seen first by a nurse and then, if deemed necessary, by a doctor.

Private medical Insurance would still be necessary for greater medical choice, or long term, specialist or other expensive care. Insurance would likely break out into two categories, with lower priced insurance covering only what the clinics did not, and a more complete coverage package, allowing choice of private medical practitioners and services from the start.

This plan would not provide insurance to more people. It would, however, create access to some level of basic health care for everyone. Right now, a person with no insurance and little money can be shut out of health care access entirely.

A system where preventative or routine care is unavailable or unaffordable for some is dangerous for patients and ultimately makes medical care more expensive for everyone. A publicly funded system of free clinics that provide preventive, routine & urgent care would lower the cost of medical insurance, free up hospital emergency rooms for emergencies, and improve health care for the uninsured or under-insured. A system of year for year tradeoffs, education for service, would allow a person, starting with nothing but the intelligence and the drive, to become a nurses aide, a nurse, or a doctor, and to do so without debt. This would fill the ranks of those who will care for us as we age.


Setting up this system will be expensive.

But it will cost less and give us more than what we have now.

Jonathan Spero
P.O. Box 16
Williams OR 97544
email: pogo@mcmatters.net