ACA ObamaCare Alternative

Why couldn’t we have a two-tiered medical system?  One tier would be the one we currently have (without benefit of the ACA).  It would stay in place.  People would be free in the open market to purchase any level of care they want or can afford.  

The second tier would be available to all and serviced, in large part, by medical practitioners who receive a full medical scholarship from a university.  Those scholarships are paid for with tax dollars.  Graduates from that group owe the first ten years or so of their careers to ACA hospitals.  The length of the ACA obligation could vary based the years of training received for their specialty.  The ACA hospital facilities would be staffed with both scholarship doctors and a group of highly paid salaried doctors.

Scholarship doctors are paid a good but reduced salary commensurate with their skills and specialty.  At the end of their ACA obligation all doctors could go into private practice or stay on in a salaried position.  This type of scholarship program could extend to nursing and other medical specialties.

We Have Room For Improvement

No ACA facility doctors (under obligation and salaried) would have any malpractice liability.  They would be subject to a complaint and review process by a medical audit board, which would set penalties for deviations from best practices.  These doctors would however be subject to criminal liability for gross negligence.

Admissions to these ACA hospitals would be for people covered by a single payer system of insurance.  This single payer system would cover all residents of the U.S., for all medically necessary services, prescription drug, and medical supply costs.  All residents would also have the option to elect to buy their own medical insurance and go to any hospital of their choosing.  This latter group could continue with whatever insurance and medical treatment process they elect.

Private hospital systems that accept Medicare payments would be required to accept ACA patients and would bill for drugs, medical supplies and services at the same rate established at full ACA facilities.

All universities that receive any public funding are required to reserve a certain percentage of their enrollment to government medical scholarship enrollees.  Other universities could opt in.  The individual universities would set their own scholastic admission criteria.  There would be no financial criteria for joining the ACA program, only the obligation upon graduation.

Under this new ACA program, universities could also get into the drug research and development business.  All drugs so developed would be sold, by the university at negotiated rates to ACA hospitals and at a reasonable mark-up to non-ACA facilities.  University profits from drug sales would go back into the drug program.  A certain percentage of drug research would be set aside for so-called "orphan diseases" where profit obligations currently prohibit development.  Federal grant monies could be made available to offset research into these not so profitable areas. 

Purchasing of drugs and medical supplies for all ACA hospitals would be through a single procurement office, which would negotiate the best prices based on their large-scale acquisitions.  The procurement process would be totally transparent and subject to continual audit from an established external board.   Drug or equipment acquisitions could be done on an international basis to get the best pricing.