Mind Games: How Might the Founders Have Approached a National Health System?

And now for something completely different... Ignoring the likelihood that they would have punted such matters to the States, I sometimes try to imagine how the Founders might have approached some of our modern problems. What might they have envisioned? They had their faults but never the less were brilliant political thinkers.

We know that they were schizoid about centralized power. It was important from the perspective of having a coherent union but also dangerous from the standpoint of potential for tyranny. (I think they would have hated Medicare.) They looked to the States to provide a better insight into the lives and direct needs of their populations and to check the run away growth of centralized authority. To a large extent the States were free to experiment as long as it didn't interfere with the common cause (not always a good thing). They did not trust the individual to do the right thing.

Is that enough to imagine the rough outlines of what they might have done? Let's take a stab at it. Here, the incongruent forces are the best interests of the individual patient and the rights and responsibilities of those who provide medical services balanced against being respectful of the societal burden of the program, both now and in the future.

The Founders had a pretty good model of strong centralization with checks and balances - our three branches of government. One, closely linked to the will of the people and empowered to determine the rules; one to administer the program and weed out new rules that might be a bit hanky; and one, distanced from the people's whim to oversee the other two and make sure the rules fit with the intent of the governmental blueprint. Not a bad model for an important program.

Could this be the model of a national health system? It's fun to consider it for a moment. Start with a simple blueprint of clinical medicine with the needs of the patient at the core. Something that includes:

"We hold this belief to be self evident that all persons in a great and just nation should be granted benefit of basic healthcare. That the purpose of this national health system is to provide clinically relevant care to all in accordance with only those limitations that threaten long term solvency, or are contrary to the science of medicine. That privacy, being critical to the free disclosure of vital medical information to the clinician, shall not be violated save in circumstances, well defined in these articles, that threaten the common health of our citizens. That clinical workflow takes precedence over administrative workflow except to the minimum required to maintain solvency and ensure patient safety. That outcome is a amalgam of patient responsibility, clinical services, societal limitations and disease science. This charter defines three branches of the national health authority: Regulatory, Governance, and Clinical Oversight."

Things like that.

Regulatory would be charged with creating the rules governing the financial and common practices. Governance would administer the program and its payment and service structure. And Clinical Oversight would consist of a judicial system of medical experts empowered to ensure that the medicine never takes second place and enforce accountability of the other two arms.

I know, its simplistic, but.....