James Hamilton is convinced that health care can be better and less costly, but the Affordable Care Act won't get America to that promising future.
Hamilton, 63, is the executive director of a physician group in northeast Indiana, and he's worked in health-care administration for nearly 30 years. Those bright prospects he sees for the future of health care are centered on “individualized medicine”; its proponents believe it will allow doctors to thwart many diseases by acting on individual genes in patients' bodies.
The ACA, also known as Obamacare, “really was nothing more than insurance reform,” said Hamilton, who lives near Leo-Cedarville. He's not looking to today's Republican Party to offer an alternative, either. Republicans “are on the same playing field as the ACA,” he said. “Just insurance reform.”
To help make his case, Hamilton has a written a book, “A Short Treatise on a Common Sense Framework for Health Care Reform,” published late in 2013. It's a thin book, only 48 pages long, but it's enough room for Hamilton to pack in an intelligently sketched outline of an alternative course for health care.
This is the foundation: Make the same kind of commitment to understanding the human genome that we made to landing astronauts on the moon. The human genome was mapped a decade ago, and now is the time to pay for years of additional research so that doctors can routinely block the action of genes and avert or reverse medical problems.
“It presses the edge of my understanding, but some of the work is just phenomenal,” Hamilton says of the emerging techniques of genetic intervention in medicine. Experts in the field typically forecast that benefits of gene therapies could be available in 10-20 years, Hamilton said.
Naturally, bringing this vision of radically better medical treatments to pass won't be simple.
The research needed in a crash use-the-genome project would be expensive, expensive enough that Hamilton has not seen an estimate and doesn't offer one himself. But he does note that actually averting the onset of costly diseases could cut costs fundamentally, instead of reconfiguring or capping payments or taxes used to fund the ACA.
And there's another significant hurdle: America has to start peeling costs out of the current health-care system during this decade or two of transition to “individualized medicine” that relies on genetic testing and treatment.
Decades in health-care administration have given Hamilton many ideas on that front, which he includes in his book, such as:
*Narrow the definition of which people among the uninsured need public help to get health insurance. He would eliminate illegal immigrants, households with incomes greater than $75,000 per year or 300 percent of the federal poverty limit, those 18-34 years old and those eligible for other government programs but not enrolled in them. That leaves the working poor, a group that Hamilton would support with a health-care safety net. In 2008, those working poor constituted 17 percent of uninsured Americans, according to figures from the U.S. census.
*Move more routine care and patient education to nurses and others, leaving doctors more time for more demanding examination, diagnosis and treatment.
*Allow insurance companies to sell policies across state lines.
*Continue the consolidation of health-care providers to promote efficiency and savings.
*Reform malpractice settlements so that payouts are more routinely linked to the types of cases involved.