Well, first of all I have tried to think of how you wouldn't need coders, regardless of the new system employed. I think at least transitionally they will be needed, for billing, for cost control, for medical records, for patient satisfication surveys etc. Now, a lot could be done with a bar coder and a scanner..the doctor does an appendectomy and her assistant scans the name of the operation, the medicines, the supplies, etc. and you have a good idea of cost. She spends 20 minutes post-op and there you can scan again. Can be done. You don't have what you need in medical records, which is some sort of human observation, so you get the gist of the patient. I don't know how this could be simplified, especially when she will probably see several doctors.

Now, we can all submit ideas as to how to fix health care. I would add how to fix it so the transition is not worse than the cure, which it easily could be. It is like steering a huge freighter and it will not turn on a dime. I am with Edwards and probably others, probably Obama, who say let's leave what works in place for now and incorporate stuff from the bottom up. I would have many many clinics all over the place and I would have public health nurses and I would have school nurses in huge numbers. Oops..nursing shortage. I would immediately get huge numbers of people in the pipeline, and a problem is the shortage of nurse instructors. I would also get all sorts of health professionals and paraprofessionals starting to be trained right now. Many could be cross-trained perhaps. I would look at training for medics and I would try to duplicate that. I would look at the prison population and train them as at least paraprofessionals. I would look at nationwide certifications rather than state ones so Nancy the Nurse could cross state lines, if she can't already. Unlike many other people, here and elsewhere, I do not presume to pontificate about licensing requirements I don't know about.

I wouldn't make health care free except to indigent people. There could be a sliding scale and people can and should pay somewhat to the extent of their ability. That would bring at least some revenue into the system.

I would look at alternative medicine. Many conditions can be helped that way.

I would train health facilitators..neighborhood people who would need very little training to follow up on people after surgery, to make sure they are taking their medicines, that they haven't fallen, that they are able to take care of themselves...

I would look into these lifeline screenings that come to your church and see how good they are for $100 instead of thousands at the hospital. I would start screening people pretty soon.

I would have mobile teams of health people who could conduct immumization clinics, move to disaster areas etc.

The biggest problem is not that insurance is bad and mean or doctors are greedy..but we have invented ourselves into a situation where the treatment for an illness can cost more than what a person can make in a lifetime. So that has to be taken into account.

Medications -- overprescribed at times and cost a whole lot. Certainly we can look at the overprescription. And people need more time to talk to health people..maybe not doctors..maybe a whole new profession..health educators..nurse educators, etc. 15 minutes of a rushed doctor's time is not going to get you more than a prescription problably. Need to look at entire lifestyle..diet, exercise, sunshine, fresh air, social support etc.

If the public is paying, as they should, they also need some crime prevention in there...they should have to pay for cancer and heart attacks...but some stuff is self-inflicted. Drug use and all the crime it causes. I am not saying don't treat drug addicts, but certainly be out in the open about some of the problems. I don't think you can be too confidential about some of this stuff and enable the drug users further. Get it out in the open and let the chips fall where they may. I am not saying out them, but don't cover up the problem either. Now routinely patients are asked at least in some places about their drug use and it is in their charts.

Fertility treatments....minor surgery yes. Vitamins and counseling yes. I don't know how much further I would go, but not to extreme measures, and I think there should be limits on the number of implants.

Well, that is all I can think of for now. We need to be training many new nurses and physician assistants and all sorts of other specialties and we have to get used to the idea most of us are probably not going to see a doctor except for major problems, and we will be just fine. mg