Healthcare reform: Universal Access to poor and rural Americans (Part 3)

We can provide health care access to the poor and the rural. We can do better. There are solutions. Photo: Associated Press

WASHINGTON, November 30, 2013 – The lack of access to the best of our health care by certain classes of people, defined by their geographical location or financial status is well known. This is a separate problem from the other items on the agenda. We have government programs to feed the hungry; to provide health care for the elderly; to protect the innocent.

We can provide health care access to the poor and the rural. We can also do better than the COBRA coverage for those who lose their jobs, or those who are excluded because of pre-existing conditions. 

There is no question that, in this day and age, the provisions can and should be made for universal health care.  It is very tempting to design a system in which no government plays a major role. 

However, the most efficient way to care for the poor would seem to be a State run program which levies a small per capita fee on each pool of insured to be placed in a designated fund, administered by the State, for the benefit of qualified citizens. A model for such a program might be the Medicaid programs in each State.  

However, access gets a lot easier if the ideas presented here are followed. In the first place, there will be fewer people in such need; secondly, health care costs will have been radically reduced by the increased pools of insured and the abundance of health care professionals; and thirdly, our culture of a patient-centered medicine will urge us to seek out those in need and minister to them because we know how, because our system allows us to see them, and because it’s the right thing to do.   

Federal involvement


SEE RELATED: Healthcare reform: Healthcare Cost, Quality and Access (Part 1)


One of the most controversial aspects of health care reform today is the proper role of the federal government in the solution of these challenges. Some critics hold that there is no place for the federal government in the health care arena, any more than in education, welfare, or care for the elderly. Clearly, the Constitution of the United States does not speak of such government services, nor were such ever envisioned by the Founders for either the federal or state governments. 

The fact, however, is that the federal government is already involved in these humanitarian enterprises, generally with the approval of previous generations. The true problem is that there is no clear criterion by which to judge whether or not a particular involvement is appropriate and justified. This is not the place to discuss the philosophical issues involved in that subject, however. Rather, there is a pragmatic rule of thumb which can be applied in this case: What is the least the federal government can do to assist in lightening the citizenry’s heavy burden of health care? Compared to Obamacare, the legislation advocated here is minimal but helpful. 

The following federal legislative acts would solve a lot of problems. New federal laws should:

Shift the tax exemption for health insurance from companies to individuals, and allow any group of citizens to organize into a pool of insured for the purpose of bargaining with insurance companies should they wish to do so.


SEE RELATED: The second answer to healthcare reform: Free access to med school (Part 2)


Federalize the charters of certain insurance carriers, so that a chartered insurance company could offer health coverage anywhere the United States.

Eliminate the need for “defensive medicine”. The law should punish medical professionals and institutions only for malicious intent, culpable negligence and incompetence. Then the penalties should be set by law. No more windfalls for trial lawyers.

Delegate enforcement of the new federal laws to the States, which already have in place enforcement mechanisms, to make sure that the insurance companies live up to their commitments without the necessity of years-long lawsuits.

Provide free tuition — at taxpayer expense – to medical, nursing, and medical paraprofessional school students, available to all qualified applicants.

The poor must have access to health care of a standard equal to that of every other citizen.  The federal government, however, need not get involved in this service. Instead, each State should initiate a small per capita tax levied on all pools of the insured and paid into a specially designated fund, administered by the State, for the benefit of qualified citizens, with the legal requirement that the fund remain solvent. The purpose of this tax would be to finance care of the poor. 

One more word: this cannot all be done immediately or at one time. One of the many difficulties of Obamacare has been trying do too much at once. But just because we can’t do everything, doesn’t mean we can’t do anything.  

Congress can take the leadership by passing this modest legislative agenda. The results will be most helpful to patients, the medical profession, the economy, and – not least of all – our national pride that we have together brought down the costs of heath care, improved distribution of the best quality of health care available, and provided humanitarian health care to every one of our citizens, no matter what their financial or geographical status is – all with preserving the virtues of the present system.       


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Lawrence J. Fedewa

Lawrence J. Fedewa is author, publisher, and speaker, he has addressed international audiences on both technical issues and events of the day. He is also a Contributing Editor for “A Line of Sight" magazine.

Lawrence J. Fedewa has worked with railroads, less-developed countries, and labor unions as a management consultant, and with professors, managers, politicians, and teachers. 

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