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The following 10 recommendations have been construed with the goals of increasing access to healthcare, lowering the costs of healthcare, and improving the quality of healthcare in the state of Nevada. Let is be stressed, these are personal recommendations, arrived at through the above statistics, analysis, study, and, of course, predisposing ideology. These recommendations should not be associated with the many people interviewed for this paper as none of them expressed any of the following views nor is it likely they would subscribe to many or even any of them. I should emphasize that the administrations of Touro and Valley were entirely apolitical in their responses to requests for factual information. A common theme heard was the desire to cooperate with UNSOM for the mutual benefit of the students and to advance the interests of the state of Nevada.
Recommendation 1: Continue to reform medical malpractice in the State of Nevada. The Democratic controlled State and House refused to pass meaningful malpractice reform in regular and special session and thus the voters of Nevada approved mal practice reform in 2004 via ballot initiative, which among other changes solidified and capped noneconomic or pain and suffering damages at $350,000. The voter approved law will be challenged in court, as trial attorneys await a 'perfect storm' case, and thus state legislative action remains imperative. (64), (65), (66), (68), (87), (107) Ultimate reform will likely involve removal of 'special' legal rules for medical malpractice, which predispose for abuse (similar solutions have been proposed for workers comp). (71), (72), (73)
Recommendation 2: Allow Nevada Residents to purchase out of state insurance on a national market. (75)
Recommendation 3: Abolish all instate health insurance requirements and regulations, including the 47+ mandates (NV ranks in the top 10 in the country for most health insurance mandates). (58), (59), (66), 67), (77) In fact, health 'insurance' in the United States is a misnomer, as the term has been corrupted, semantically diverted to placate the social planning appetites of politicians. (69), (70), (71) For background, mandates are treatments and conditions that must be covered by anyone offering health insurance. Various medical interest groups lobby to have their treatments covered and collectively these drive up the price of health insurance. For example, in Nevada it is illegal for health insurance not to cover 40 inpatient and 40 outpatient days in mental health benefits. (67)
Recommendation 4: Expand the recently passed measure, sponsored by State Sen Joe Heck, to allow importation of pharmaceuticals from Canada to include other countries and eliminate the 'FDA approved' requirement. (59), (60), (61), (62), (63)
Recommendation 5: Liberalize Nevada medical licensing laws. (87), (90) Allow patients the option to see other medical specialists instead of physicians and vice versa. (45), (88) Strengthen the power of state professional group associations to self regulate and police their own members and encourage said state and their respective national organizations to attain greater uniformity in interstate licensure. (89) In lieu of the aforementioned, ratify and pursue such models as the nursing compact:
The Nursing Licensure Compact is a mutual recognition model of
nursing licensure that allows a nurse to have one
In addition, eliminate political control and influence over state licensing boards by removing the governor's power of appointment to these boards. (76), (86)
Recommendation 6: Privatize all state funded medical education institutions. As this paper purports to illustrate, private industry can supply the training of healthcare workers more efficiently and cost effectively than the state. Removing state subsidies will allow private industry to grow unimpeded and without competing with area physicians and other healthcare workers. In addition to relieving Nevada taxpayers by cutting state spending, the millions of dollars of generated out of state investment provide significant economic benefit. At minimum, halt future increases in funding. (35)
Recommendation 7: In the same vein as recommendation 6, shelve all plans for a 'Health Science Center', and/or a 'Nevada Academic Medical Center', and ax any current state funding of residencies or research facilities. (35), (50), (51), (85)
Recommendation 8: On a federal level, eliminate all federal spending and subsidies (over $7 billion per year) on residents and fellowships (20). While this influx of $$$ has led to some encouragement of residency programs, the stipulations and requirements have created, if the figures are even to be believed, to reoccurring cycles of gluts and shortages, disproportionate congregation and standardizations of facilities (by exclusion), and a resulting diminishing of the educational experience coexistent with horrendous financial inefficiency (103). Private donors, hospitals, future medical employers, and the students themselves are more than capable of shouldering any increased financial burden. This could also apply to the tuition of medical students, through state and federal loan subsidies. In other unregulated industries, expensive tuition reflects salaries in a much gentler supply and demand driven cycle.
Recommendation 9: Encourage professional organizations and their subspecialty affiliates to facilitate residency approval and eliminate costly and timely compliance. The best form of encouragement may involve liberalizing licensing laws, removing the current legal monopolies and raising the threat of competition, concomitant with loss of federal GME subsidies. (45)
Recommendation 10: More of a general recommendation than specific: get government off the backs of those in the healthcare business and industry. Liberalize regulations for small businesses (many doctors run their practices as small businesses). Lower taxes on doctors, insurance companies, hospitals, and all other healthcare providers, either on their businesses, personal incomes, or if the moon is blue, both. Allow hospitals to expand and franchise without undo paperwork or zoning tripups. General tort reform, best accomplished by limiting the number of laws and K-12 education reform are always helpful. In short, make Nevada a great place to live by returning to the roots of what made it prosper in the first place: freedom.
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