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Firstly we need a public-private partnership philosophy. Australia is a good example where this works excellently. That means public and private, not just private. American core business and social philosophies are based on capitalist principals so any new approach to healthcare must combine the need for profits in certain sectors of the health system, with the need to develop a number of core public health services that may be less likely to ever achieve a profit.

Of course all sides are exaggerating and taking up extreme positions. They will all in time compromise and hopefully reach some form of agreement. The sad part is that at present they don’t seem to be thinking of the person at the center of all this – the patient. It is widely acknowledged that healthcare costs far too much in this country, while at the same time at least 47 million Americans are uninsured. So, from a patients perspective, if you do have health insurance, you are paying way too much for it, and getting poor value, and if you don’t have it, then you just continue to suffer. What a dreadful choice. What an indictment of America.

Funding for care has to involve choice and should be provided in many instances through payment for annual or episodic whole of person care, rather than on individual piece rates as at present. These capitated payment systems work well for Kaiser Permanente, and in Britain. The primary gain from this approach is that it tends to force more resources into the prevention of illness and wellness promotion, rather than into the treatment of illnesses that have already commenced.

The private component would be funded with the aid of broader tax incentives or similar financial tools to encourage most people (or companies) to take out private insurance. The aim should be that at least 80-90% of the population should have private insurance, whether it be comprehensive insurance, or top-up insurance to support core government provided insurance.

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