Eliminate Fee for Service:  Medical tradition in the US has been to charge for each service provided. This has led to an explosion of unnecessary testing (partly due to liability concerns by doctors), and a dramatic increase in costs without any evidence extra tests make us healthier. We must develop a system where costs are allocated based on maintaining the health of the patient and should not be measured by the number of test performed. Fee-for-service cannot continue in its present form if we hope to reduce the growth of medical costs.
 

Reduce Waste in Administration:  Fragmentation of services makes management of costs impossible and leads to administrative overheads of 25% to 30%. We must develop systems that can lower these costs.
 

Malpractice Reform:  Malpractice costs have risen dramatically, pushing doctors to protect themselves by ordering extra tests even if they are unsure the tests are necessary. This must change. One option is to create special courts to handle malpractice claims to avoid presenting difficult technical cases to untrained jurors.
 

Reduce Fraud and Abuse:  Estimates of Medicare fraud range upwards to $90 billion per year. In some parts of the country the most lucrative crime is no longer selling drugs but engaging in Medicare fraud. Congress must get serious about stopping this waste.
 

Coordinate Care Through Primary Care Physicians:  Better utilization of PCPs, who would be responsible for the overall success in managing patient care, will reduce costs.
 

End-Of-Life Counseling:  While some might call end-of-life counseling “pulling the plug on grandma”, this is a shameful exploitation of a simple fact - we all die. Where we die and how we die, given the amazing ability for medical technology to keep us alive, should be our choice, if possible. Decisions between patient and counselor that reflect the dignity of life and the path we all must take are appropriate, and can lead to lower end of life costs while meeting the needs and desires of the patient.
 

Manage Chronic Disease:  We create many of the problems that lead to higher medical costs. Lifestyle abuses have led to an epidemic of obesity, diabetes, and heart disease. Implementing programs that monitor a patient's health in real time and encourage lifestyle changes will lead to a reduction in health care costs.
 

Wellness Programs:  Recognizing we can have a positive impact on costs, wellness programs should be implemented to encourage greater personal responsibility for our own long-term health.
 

Universal Coverage:  The US spends 2x the amount of money on healthcare compared to other developed countries. If we can accomplish essential changes to the health care system to reduce costs, we will be able to offer universal coverage for basic and essential healthcare to all citizens. Given our system for treating anyone who comes through the doors of a hospital regardless of ability to pay, we already have a dysfunctional universal system that serves no one well. Let’s spend our medical dollars efficiently so we can cover all our citizens.