Medical Service

[Jonathan Buhacoff]

Summary of the proposal:

The Medical Service is an institution that, like the military, is not part of government but is funded by government and exists to serve the people in a special way. The Medical Service recruits, trains, and deploys doctors, nurses, assistants, administrators, medical directors, operations officers, and other support staff for the study and practice of medicine in providing healthcare to the public.

The Medical Service would be the foundation of the people’s healthcare and would operate public hospitals and clinics everywhere they are needed. The Medical Service would be a pure expense to the people for the purpose of providing healthcare, and would therefore be aligned with providing the best possible healthcare with the available resources. Patients who are treated by the Medical Service do not need insurance and do not need to file any claims. Patients do need to be identified for the purpose of maintaining a medical record and recognizing patterns in order to help them and others better.

If a patient needs care that the Medical Service does not provide, or if the doctors in the Medical Service are unable to diagnose the patient with a treatable injury or illness, the patient will be referred to a doctor outside the Medical Service if possible. However, the government will not be paying for such external treatments — people who are concerned about the cost of such private treatments should maintain private health insurance for that purpose. Also, if a patient needs care that is provided by the Medical Service but involves a waiting list and the patient does not want to wait, the patient can be referred to a doctor outside the Medical Service and will need to pay for that themselves or with private insurance if they have it.

The Medical Service would eliminate the enormous expense currently incurred by federal and state governments in the United States to run so-called healthcare marketplaces, which are really catalogs of subsidized medical insurance plans, the expense of supervising providers participating in Medicare and Medicaid, the expense of Medicare and Medicaid fraud, delays in treatment that are due to waiting for insurance to approve treatment, and under-treatment resulting from insurance companies denying authorizations. Taxpayers would instead be funding an organization dedicated to public healthcare without a profit motive and without layers of bureaucracy for approving insurance claims. The result would be essential healthcare provided to the public at the lowest possible cost and without unnecessary delays.

The Medical Service would not eliminate private medical practice, just like the military and the police haven’t eliminated private security, and just like the Judicial Branch has not eliminated private mediators, and public defenders have not eliminated private defense attorneys.

Organization

The Medical Service should not be part of government for at least these reasons:

* practitioners and staff who are part of the Medical Service are significantly different in purpose, authority, training, appearance (uniform), and duties than civilians who are part of government
* the Medical Service has its own ethical code and disciplinary procedures which are different than civilian laws and judicial procedures
* the Medical Service should be responsive to properly issued and lawful directives of the Executive Branch, and must have the ability to refuse to follow unlawful or improper orders, which means the Executive Branch should not have the power to summarily dismiss medical officers and the implication is that that the Medical Service cannot be part of the Executive Branch
* the Medical Service certainly doesn’t fit in any other branch of government

Instead, the Medical Service should be an institution that is separate from government, yet directed exclusively by the government. The separation means that:

* The Medical Service is not a branch of government
* Members of the Medical Service are not government employees
* The Legislative Branch funds the Medical Service in its budgeting process
* The Legislative Branch must enact laws to govern the pay, benefits, and discipline of members of the Medical Service separately from government employees, elected or appointed officials, and other civilians
* The Legislative Branch confirms the appointment of the highest-ranking officers in the Medical Service
* The Executive Branch is responsible for directing the actions of the Medical Service
* The Investigative Branch is responsible for holding Medical Service personnel accountable to all laws and regulations and may have a special division focused on Medical Service investigations
* The Judicial Branch hears cases where Medical Service personnel violated non-medical laws or regulations, such as if a practitioner abuses their spouse or children, or is stopped by police for a traffic violation outside of a medical complex, etc.

The Medical Service has its own systems for training personnel, developing medical regulations, and administering discipline within the boundaries set by the Legislative Branch.

Disaster Response

The Medical Service would have some designated first response teams, and all members would be able to help if needed. However, when deploying large numbers of medics, the Medical Service should leave some medics in reserve to continue treating their local population for the most urgent conditions.

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