ittee was able to come up with a hypothetical plan that would divide the United States into 110 health regions. These would vary greatly in geographical size, sometimes covering less than a county within the largest cities, and with the largest one perhaps covering the states of Wyoming, Montana, and Idaho. One reason for this structure that Dr. Hiatt does not emphasize is that it gains strength by paralleling our national state-Federal structure, in which many local decisions are handled at the state or county level, with the Federal government providing only funding and overall policy coordination. The convenience of having regions coincide with state borders would, however, frequently by overruled by the importance of having regions be as geographically compact as possible, in order to minimize transportation problems in getting patients to urgent care in urban centers.
The key concept in the model is that of the creation of a federally chartered, not-for-profit Regional Health Corporation. Two of its five directors would be appointed by the President, the other three by the stateÆs governor; one of these must be on the regional business council, another a representative of a major union; these would then elect or hire a CEO on the basis of his or her health-care expertise. Although Dr. Hiatt does not emphasize this, it should be clear that the federal corporate charter is crucial. It is the fact that the giant corporations are chartered by individual states, which cannot stand up to them politically, rather than by the federal government that makes economic and other reforms so difficult in the United States, at least in the opinion of many liberal reformers.
The major and essential role of the Regional Health Corporation is that it would become the single collector of all medical insurance premiums, which would be handled essentially like a payroll or Social Security tax, and the single payer of all medical fees and re...