by Susan Winters
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Even before the Affordable Care Act, Gil Lancaster has felt that the US healthcare was flawed. He knew that a system that was science and evidence based would help the most people and keep costs down. The system at the time, and the new ACA were based on government and business, not science.
Back in 2007, Lancaster found himself at a fundraiser for now Congressman Jim Himes. Himes was asked what he knew about Health Care Reform. The young candidate admitted that he didn’t know enough but that he was willing to learn. He invited many of the doctors present that day to help educate him.
Soon, Lancaster got together with Redding doctors Kim Yonkers, Charles Landau, Steven Zamore and others to discuss the problems not addressed by current health care. They knew that there was a financial burden on both patients (co-pays, premiums and out of pocket expenses) and on the doctors themselves. Many of their practices had to hire a full timer to handle billing and insurance. The mountain of paperwork involved in reimbursement and documentation was only growing.
The doctors agreed that Universal coverage that was guaranteed and affordable was needed.
Lancaster went home from this meeting with many ideas formulating. He said that there are so many systems that don’t integrate with each other like Medicare, the VA and Indian Affairs. There is no overview or prevailing body to assure continuity. Also, each hospital group has its own system that didn’t communicate with others. For example: in this area if your doctor is in the Danbury/ Norwalk area and you see specialists in that system, they can pull up all of your records and tests. But, if you then go to a doctor at Yale New Haven, they can’t access your records.
There needed to be an infrastructure configured to that guidelines could be easily used by all.
He put his thoughts together and came up with the EMBRACE plan (Expanding Medical and Behavioral Resources with Access to Care for Everyone) which he calls “a revolutionary new healthcare system for the twenty-first century.”
Lancaster said, “There were dozens of others who worked on the initial idea and I had 7 coauthors on our publication in the Annals of Internal Medicine. The book is really just an in-depth report of all the ideas we discussed when the plan was developed.”
EMBRACE calls for a non governmental board in charge of this system, similar to the Federal Reserve. The chairperson would be appointed, but also be independent. The board itself would be comprised of all concerned groups having a seat at the table. Doctors would be able to determine science based patterns and 21st century innovations to advance health care for all.
Healthcare would be set up in Tiers.
- Tier 1, the base level, would cover the entire population from cradle to grave. It would include all medical, surgical, and psychiatric therapies considered to be life saving, life-sustaining, or preventive on the basis of the best evidence (from the medical literature and expert opinions). This tier would be completely covered at no cost to the patient. In the past people spent high amounts on catastrophic care with high deductibles. They then ignored their day to day health because it would be out of pocket. This tier is the exact opposite. NO CHARGE for wellness visits and life sustaining care.A government-subsidized account similar to Medicare would provide the funds, with the elimination of all other public insurance.
- Tier 2 would cover all therapies considered to help with quality of life, as well as some diagnoses or services that do not have sufficient evidence for a Tier 1 indication.Private insurance carriers would administer Tier 2 services with low cost plans. The monthly premiums would be low because insurance would not have to cover the expensive major ailments like cancer treatment because that is completely covered in tier one. Private insurance would be completely optional and people could elect to pay for these ailments out of pocket.
- Tier 3 would apply to all medical and surgical issues considered luxury or cosmetic, such as Plastic Surgery, Botox and Lasik. Funding for Tier 3 would not be covered under the EMBRACE system—as in the current system—and all bills would go to the patient.
- Pharmaceuticals will have similar tier assignments for medical coverage: Tier 1 would include formulations and therapies that treat or prevent serious illnesses and would mostly be paid for by public funds or be heavily subsidized. Tier 2 would apply to drugs and therapies that enhance quality of life and would be covered by private insurance. Tier 3 would be for luxury items.
- Records would be kept in a web based system that allows universal access for doctors and patients. Tests and files would be stored here and bills would be sent from a centralized location.
Lancaster said that doctors would be able to make decisions for their patients without insurance company and government interruption (example: doctor wants patient who is in pain to have an MRI.Insurance company says they need an X ray first, although it won’t show the doctor what he needs to see. Patient gets X ray and then the doctor has to get the authorization for the MRI. Two weeks have now passed and the patient is still in pain…)
Dr. Lancaster has spoken to countless doctors, as well as economists and software experts to make sure this plan can be executed. His paper was published in the Annals of Internal Medicine. The plan is now in book form which can be ordered here.
In his new book, Dr. Lancaster not only explains the need for a new healthcare system like EMBRACE but also demonstrates how it might feel to live in the United States with such a system. Working under the assumption that the reader has no background in the subject, he provides an idea of the possible effects of EMBRACE on consumers (patients), doctors, hospitals, businesses, and even government.
One of the biggest advocates for EMBRACE is Congressman Jim Himes, who did not forget his promise to make health care reform a priority. He has introduced the plan to many of his colleagues and has received positive feedback from those on both sides of the aisle.
A great advantage is that taxes will not go up because of the plan.
Redding doctors weigh in on the plan:
- Dr. Kim Yonkers said, “I think the plan is a thoughtful alternative to the system that we have now and is very egalitarian.”
- Dr. Charles Landau (cardiologist) felt that, “As with all plans, the devil is in the details. At the extremes, the decisions about what illnesses belong in each tier is straightforward, but there are many diagnoses or procedures that improve quality of life, but have no effect on longevity. Deciding if these belong to the funded or unfunded tier will not be simple.”
Born in Chicago to Israeli parents, Gilead Lancaster moved back to his parents homeland when he was two. At age seven, he moved back to the US with his mom and her new Australian husband. He smiles when he remembers that among his new blended family, he was the only American citizen but also the only one who spoke no English. In 1988, he married Mary Dale Jones. They have lived in Redding for many years with their son, Peter and daughter, Chloé. They continue to reside in their lovely tree shaded home even though it is now an empty nest. I interviewed Mary Dale in June. Read about Gil’s fascinating wife here.
Lancaster went to college at Columbia and medical school at the University of Tel Aviv in Israel. Dr. Lancaster is a cardiologist practicing at Bridgeport Hospital. He is the director of the hospital’s non-invasive cardiology testing laboratory and a consultant on heart patients in the hospital and at an affiliated outpatient clinic. In addition to his clinical work, Dr. Lancaster teaches medical students, medical residents and cardiology fellows and is an Associate Clinical Professor of Medicine at the Yale University School of Medicine.
Visit theembraceplan.org for more information and to order the book.