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OPEN LETTER TO TEXAS US SENATORS AND INNOVATIONS IN
CONGRESIONAL REPRESENATIVES MEDICAL PRACTICE
Now that Repeal and Replace is on hold, I would like to in- A PROPOSAL FOR BETTER
troduce myself and submit suggestions for an effective health ACCESS TO CARE
care program. I am a Vietnam veteran who developed an in-
terest in medicine as a result of military service. After a long, By R.V. Osbourn, MD
arduous processes I became a primary care physician. As pri-
mary care is problematic, I developed an understanding of the As the Affordable Care Act has been partially implemented, it is evi-
administrative process as I earned a Master’s in Public Health dent that it is neither affordable nor simplistic. Yet the question from
(MPH) and boar certification in Preventive Medicine and Ur- the pundits remains: “Do Republicans have any ideas about health care?”
gent Care. Today I am semi-retired and provide primary care This proposal, from a conservative Republican physician, concerns the
services to various Texas correctional facilities. principle of access to care by a physician. Health care needs supervision
by physicians, not midlevel practitioners. As such, it is essential for a
My suggestion is that any program must be based on the fully licensed physician to evaluate and to implement investigations, pa-
concept of physician-directed health care. Physicians have the tient education, and treatment. Ancillary health care professionals assist
education, training and experience to provide so-called quality physicians and have sufficient knowledge to present information to a su-
health care leadership. All health care should be physician-di- pervising physician and aid in treatment. Also, it will be beneficial to in-
rected. Mid-level providers should continue to function under volve social workers in this endeavor, for they have knowledge of health
physician supervision and not be independent practitioners. care funding and resources. I am concerned about access to care by a
physician and would like to propose a community-based health care pro-
Whether health care is a right or a privilege, any health care gram. In the United Stated, there are four levels of government: local,
program must involve a cooperative relationship between our county, state, and federal. In many instances, the resources of the first
citizens, private enterprise, the health insurance industry and two are combined.
all levels of government, federal, state and local. Almost every
county in the U.S. has a health department and, as such, it can Traditionally, most counties have health departments. State govern-
be an effective site for implementation. Physicians can be re- ments also have health departments funded by the legislatures. There is
cruited to provide primary care services such as health screen- also funding for health activities, such as state hospitals and professional
ings, immunizations and health care counseling. Local health schools. The federal government has assisted state and local public health
departments should be staffed with administrators and social activities mostly through granting processes. The objective in proposing
workers who can refer to specialty care providers and coordi- a simplistic health care system is to provide public health services to the
nate payments. public by using all levels of government. With a cooperative intergov-
ernmental relationship, it may be possible to provide for the severely im-
However, there are many false conjectures often advertised paired and the catastrophically ill, as well as the uninsured and
on television. Many are of little or no benefit. Some are actually underinsured. Emergency and disaster services should also be included.
harmful and may enhance infection, promote chronic illness The local government could provide the facilities in which health care
and are actually toxic. Thus, it is essential that a health care services can be delivered; the states can provide funding, as well as health
program works to prevent the advertisement of medications personnel from professional schools. The federal government should be
and treatments of questionable value. This is especially relevant able to position itself in the development of a professional cadre of health
now that our society has recognized the persistence of the ia- care professionals as commissioned officers of the U.S. Public Health
trogenic opiate addiction. Service (USPHS).
What I am proposing is a health care initiative to be devel- The Commissioned Corps of the USPHS has been in existence since
oped by the U.S. Public Health Service. New agencies do not 1798. Currently, it provides medical support to the Coast Guard, the
need to be invented. What I recommend is enhanced funding National Institutes of Health, the Food and Drug Administration, and
for the USPHS Reserve. I recommend that this funding be other agencies. USPHS has a reserve component that may be funded to
through non-appropriated monetary assets such as state lotter- develop a reserve component similar to the Reserve Components of the
ies and a possible federal lottery. Additional assets may come Armed Forces. It may then be integrated into the National Guard for
from criminal fines or the interest on FHA loans. The USPHS community service. As such, professionals could provide services on a
may also be tasked with sponsoring Health Saving Accounts part-time basis, and earn a salary, retirement credits, and military privi-
and in the purchase of health insurance across state lines and leges. Those who participate would be able to receive their own compli-
most favorable for the purchaser. mentary health care insurance for themselves and their dependents. Their
professional activities would also be covered by the Federal Tort Claims
I was able to publish my ideas in a letter to the Texas Medical Act. Patients should be charged on a sliding-scale basis. No one should
Association in Texas Medicine June 2014. See below. be refused for lack of resources. Novel methods of funding from no ap-
propriated sources should be encouraged, such as lotteries, court fines,
Sincerely, seized assets, and lease of government assets. There may be many other
Raymond V Osbourn, MD,MPH ways of funding. I’d like to hear your suggestions. You may email me at
211Tranquil Oak rvosbournmd@aol.com or call 210 403 2176.
San Antonio, Texas 78260
June 2014 TEXAS MEDICINE visit us at www.bcms.org 21
