This book presents a bold and comprehensive proposal for addressing the ongoing health care crisis in the United States, focusing on a hybrid health organization (HHO) plan that aims to improve access to care while controlling costs. The author, Dr. Eugene H. Schmitt III, draws upon his sixty years of extensive experience in health care to highlight the systemic issues plaguing the current health care delivery model. The book identifies critical problems within the current health care system, including rising costs and limited access to care. It emphasizes that the existing model, which assumes that all medically indicated care should be covered by insurance, is unsustainable due to the increasing complexity and expense of medical treatments.

Proposed solutionsDr. Schmitt's HHO plan breaks down medically indicated care using ICD-10 and CPT codes into four distinct categories: basic, lifesaving, and catastrophic (which are essential), as well as elective. This categorization allows for different payment structures and prioritizes essential services while offering flexibility for elective procedures.

Basic care: Defined as essential, preventive, and urgent care, basic care is to be funded through health savings accounts (HSAs) with state government support for low-income individuals.

Lifesaving care: Managed through capitation fees paid directly to hospitals/health care systems, this level will incentivize cost control and quality care.

Catastrophic care: Funded by federal government reimbursements for costs exceeding a set threshold (e.g., $250,000), this category will ensure that high-cost treatments remain accessible.

Elective care: Covered by optional health insurance policies, this form of care will allow patients to choose the extent of their coverage.