Oh, I don't know... perhaps raising the retirement -- read SS & MC age eligibility in a responsible fashion reflective of the advances in life expectancy... turn these back into safety nets rather than foundation retirement programs. Appeal the SGR and budget neutrality methodologies in favor of a system that reflects the costs of providing the services (they already have the metric for this in place, the MEI). MC shortfalls will have to be addressed in one of two ways: increase revenues (taxes) or curtail the amount of services. Go forward with the funding for comparative effectiveness / value based research; at the same time you must either find some way to incentivize continued innovation or accept the stifling of innovation that would occur under the decreased monetary return model that would result from this. Novel drugs should retain the long patent protection period.... Make health insurance individually owned so that it may be portable between jobs; tax health insurance benefits equally regardless of who is paying for it... eliminate in-network/out of network barriers from patients choosing who their provider will be, on and on.
Distilled down -- we, as a profession, need to determine what treatments work and be sensitive to the costs associated with the treatment. Payors need to decide what services they are willing to cover, have this list of services clearly enumerated and posted for everyone to see, and then pay appropriately based upon the risk, time, work, and resources consumed in providing said care (one of the strengths of the RBRVU system I must admit is that it affords some subjective, quantifiable rationale for our charges).
Or we could just go to a cash system where we are paid what the market is willing to bear, we pay our staff what we can afford to pay them, and let the chips fall where they may...... (said partially tongue in cheek) Patients could still have insurance that helps reimburse them after the fact..... but that would never fly (and I would probably be poorer because my charges would more than likely go down if I believed that folks were having to pay out of pocket).
