Towards a Simpler Solution
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* Eric Enberg
* Dan Swartz

**We try to publish authors’ responses in the same edition with readers’ comments. Time constraints might prevent this in some cases. The problem is compounded in a bimonthly journal where continuity of comment and redress are difficult to achieve. When the redress appears 2 months after the comment, 4 months will have passed since the article was published. Therefore, we would suggest to our readers that their correspondence about published papers be submitted as soon as possible after the article appears.** 

*To the Editor:* In response to Dr. Geyman’s article (Family Practice in a Failing Health Care System: New Opportunities to Advocate for System Reform. J Am Board Fam Pract 2002;15:407–15), a rallying cry for a national, government-controlled, single-payer system, we would offer an alternative step toward a much simpler solution for health care reform. It is called Simple*Care*.

Here is how Simple*Care* works: Patients pay a small annual administrative fee ($20 per individual or $35 per family) and then pay their providers at the point of service. Because providers eliminate costs associated with producing insurance claim forms, coding diagnoses and procedures, referrals, authorizations, payment delays, EOB reviews, claim denials, resubmissions, collection risks, and other managed care costs, they offer patients a “fair price” for services without the administrative hassles and bureaucracy. According to the Simple*Care* Web site ([http://www.simplecare.com)](http://www.simplecare.com)), many physicians reduce their standard billed charges 30% to 50% for Simple*Care* patients and benefit financially. To protect patients fully in case of a medical emergency that would result in financial disaster, Simple*Care* should be combined with a high-deductible, major, catastrophic health insurance policy.

Simple*Care* has a number of advantages: (1) it is provider and patient driven rather than being driven by the insurance industry or government, (2) which avoids bureaucracy and socialized anything, (3) leading to considerably reduced health care costs, (4) while empowering patients with choice of provider and services, (5) yet retaining market constraints that encourage patient responsibility for seeking service and fair prices from providers when charging for services. (6) Additionally, the minimal annual fee allows small businesses to provide some health care benefit for their workers and is likely affordable for the “working poor,” who have no work-related health benefits but earn too much to qualify for government aid.

We realize that Simple*Care* system is not a panacea for all our ailing health care system woes. Simple*Care* is an excellent idea for helping the millions of uninsured Americans afford health care. There are still important issues that need to be addressed, such as coverage for prescription medications and the role of a government safety net for those who cannot, by unfortunate circumstance or poor decision making, afford even fair market prices for health care. The roles of Medicare and Medicaid need to be reconsidered in respect to the latter issue. We would also argue that in addition to switching to a much more efficient system, such as Simple*Care*, other systemwide reforms are mandatory to reduce the burden of health care expenditure, the foremost being prompt tort reform that limits damages in malpractice suits. Another useful reform would be to allow everyone the opportunity to contribute to a medical savings account and to carry over any balance for the next calendar year, if unused.

Although any transition will have difficulties that need to be worked through, and although no system will benefit everyone as they would like, we remain optimistic that health care reform can benefit both patients and providers and decrease bureaucracy