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In the 1930s, President Franklin Roosevelt began a campaign to construct and maintain U.S. Public Health Service (USPHS) Hospitals, to serve the Military, veterans, and the general public. Until 1981, the hospitals operated inpatient and outpatient services, emergency, surgery, and rehabilitation wards. In 1980, President Ronald Reagan announced plans to close or sell all such hospitals.
To replace the ACA, which is forcing people to purchase insurance and subsides with huge deductibles, I suggest that the United States Public Health Service reinstate the U.S Public Health Service Hospital system. The USPHS would obtain facilities or co-locate with community based health departments to serve the uninsured and Medicaid patients. The program can be staffed by USPHS and working with state medical schools to provide doctors, Physician Assistants(PA), Nurse Practitioners(NP) and Interns. The State can mandate that all licensed physicians perform some Pro Bono services as a requirement to be licensed in the state. While performing in the USPHS they would be covered by Government service umbrella and no additional malpractice insurance. Local community based facilities, such as health departments, can provide basic health services and referrals to larger USPHS Hospitals for more advanced treatments and diagnostic procedures.
This would be creating local jobs for medical administration as well as practitioners in local communities. Many hospitals throughout the country have had to lay off workers and staff due to loss of revenue. This provides a skilled pool from which to draw from. It would also encourage people to enter the medical area for needed workers. It would open the doors for PAs and NP as well as support staff. Creating jobs and providing the medical care desired.
The funding could come from the Medicaid as well as the funding from the ACA subsidies funding. All persons already under Medicaid would be covered. Any person can apply based upon a needs base and sliding scale for co pays and service fees.
This service would provide for the undeserved population providing health services without deductibles. The Veterans Administration provides a similar service for all Veterans. Costs are based upon a needs base and scale. The USPHS could be developed to provide the same services to the uninsured and low income.
Insurance companies would fight this tooth and nail because; it takes away the one trillion dollars from them and gives it to the people for medical treatment. People that are employed and have insurance will still have their insurance and their doctors. Most Doctors now are refusing Medicaid patients for all sorts of excuses but really because Medicaid does not pay but s fraction for the Doctors fees.
I know there would have to be a lot of work defining this program but, we start with a premise and develop the program. Before many shoot it down just consider how to make something work and suggest improvements.
I really like this but I would I like to see it practiced more like the National Guard, having Commonwealths and States running their own show. Also, seeing as there is discussion in the news recently about downsizing Active duty and giving more power to the Guard, I would really like to see Guardsmen who have MOS's(jobs) needed in these hospitals to have an option or an easy way to take on duty there. They would be "active" Guard essentially, just fulfilling the job needed in that hospital.
I do not think the States can over see the USPHS. Just as states do not oversee VA clinics or hosipitals. To ensure equal treatment in every state the same standards under the USPHS. The USPHS is considerd a uniformed service under federal codes. A Guard member could work just as Guard do now work for other agencies and even as techs.
Frankly, I think a single payer health insurance system, based on expanding Medicare to everyone and improving Medicare, would be much simpler and more effective.
Probably cheaper in the long run.