Now that House Republicans have voted to end Medicare and Medicaid as we know them, I believe it’s time to look at the real problems with the system. In addition to Medicare fraud, many of the problems are structural. Not with Medicare. But with the health care industry itself.

Unless the skyrocketing costs of health care are controlled, we will not be able to fix our social insurance programs such as Medicare. Moreover, we will not be able to control our deficits. That is precisely why President Obama and the Democratic Congress chose to focus on health care reform in 2009. Unfortunately, the resulting bill was a compromise with Republicans hell-bent on protecting the insane profits of the health insurance industry and PhRMA (Pharmaceutical Research and Manufacturers of America).

Therefore, I humbly offer the following suggestions for consideration:

1 – Create a medical triage system with the entry point being Board Certified Family Nurse Practitioners, rather than MDs. These people are Registered Nurses with additional education and training. They are more than capable of identifying and treating the majority of illnesses and symptoms, as well as writing prescriptions, and they can refer patients to a physician or specialist as needed. However, they are billed at a lower rate than physicians. Implemented nationally, this system could save millions, if not billions, of dollars.

2 – Encourage patients to call medical professionals more often. Ignoring symptoms usually doesn’t make them go away. Patients of all ages tend to avoid talking to medical professionals until they absolutely have to. This often results in illnesses being allowed to advance which, in turn, makes them more difficult (and expensive) to treat. All patients should be encouraged to call or visit with Nurse Practitioners whenever they notice a change in their bodies or a symptom of concern.

3 – Eliminate unnecessary tests and treatments. Currently, (some) doctors order a battery of lab tests and treatments in order to maximize their profits. They also claim to do this as a defensive measure against potential malpractice suits. I believe it’s time to recognize that everyone makes mistakes (including health care professionals). We should try to limit the number of malpractice suits and the size of the awards. At the same time, the medical profession needs to more aggressively weed out those who are responsible for the most egregious errors.

4 – Regulate the cost of pharmaceuticals. Currently, Big PhRMA is able to charge whatever it wants for its products. In some cases, the mark-up on pharmaceuticals is astronomical. An inhaler used by millions of Americans costs $38-$40 in the US. But in other countries, its price is as little as 5 cents!

5 – Create incentives for family practice physicians. Too many of our medical students focus on specialties that offer the greatest return on the investment of their medical education. They reason that, since they will be faced with the daunting task of paying off tens of thousands of dollars in loans, they should choose the specialty that pays the most and faces the least probability of legal issues. As a result, the percentage of family practice physicians and OB/GYN physicians is dwindling. This could be fixed by offering more government scholarship awards and tax benefits to those who choose the traditionally lower paying specialties.

6 – Eliminate the need for the poor and uninsured to use Emergency Rooms for primary care. We’ve all heard stories of people who call an ambulance in order to be transported to the ER to be treated for a common cold. Of course, since many of these people can’t afford to pay for their care, the costs are absorbed by the hospital and passed on to other patients.

Recognizing that many of the stories are likely exaggerated, it is true that people go to the ER when a simple visit to a doctor’s office would suffice at a fraction of the cost. But rather than complain about the phenomenon, we should look at the cause. Often it’s simply because these people don’t have ready access to any other form of care. By creating more and better access such as clinics staffed into the night by Nurse Practitioners, people would be encouraged to seek care through more appropriate means.

7 – Demand that health care providers publish outcomes for the most serious ailments and treatments, and encourage patients to seek out the most successful providers. It is a well-accepted fact that it is less expensive to seek treatment from the most successful providers, even if that means traveling out of state. There are fewer complications and patients tend to recover faster.

8 – Last, and most important, take the profit out of the health care industry for those who aren’t directly involved in providing care. In other words, contrary to Republican beliefs, eliminate the middle men (insurance companies) and allow the government to finance care through taxes and/or withholding. I’d much rather have the government determine the accessibility of medical care than large corporations whose primary goal is to limit care in order to maximize profits.