If, back in 2009, Barrack Obama had proposed a big expansion of theHealth Center program with the goal of giving people a "governmentoption" that worked, we would be better off right now. (Photo:suphakit73/iStock)

Since the passage of the Affordable Care Act in 2010 and itsactivation in 2014, there has been a huge amount of debate aboutwhat form our health protection system should take. (I amdeliberately avoiding the word health insurance.)

For many, the answer has been very plain and simple: Do awaywith insurance companies' involvement in providing protection forpeople's health care needs, and have the "government" take over allresponsibility for coverage. That's the Medicare for All group.

Related: If ever there was a time to rethinkemployer-sponsored health plans, this is it

Another segment of our country fears the growing power, cost,and mismanagement that often accompanies government programs. Onedoes not need to look much further than the pretty clumsy way theAffordable Care Act made its way into its first days of operation,with massive computer failures and an inability for people to beenrolled in a timely basis, to have fear of governmentmismanagement.

A third constituency is very much in favor of employer-sponsoredcoverage and bemoans the fact that the Affordable Care Act evercame into existence, with its high deductibles and cost-sharing,long wait lines, flimsy networks, and volumes of rules. The pointis, with an adult population of some 200 million adults between theages of 20 and 64, there is room for a lot of different ideas andnew ground to be explored.

What's here now

A branch of the U.S. Department of Health and Human Servicescalled the Health Resources and Services Administration (HRSA) hasa Health Center Program.

These HRSA Health Centers were news to me.

According to a fact sheet created by HRSA Health Centers,

For more than 50 years,Health Centers have delivered affordable, accessible, quality, andvalue-based primary health care to millions of people regardless oftheir ability to pay. Not only are Health Centers serving 1 in 12people across the country, the Health Center Program is leading thenation in driving quality improvement and reducing health carecosts for America's taxpayers. Because Health Centers provide highquality primary care services across the country, the Health Centernetwork is also called upon to support public health prioritiessuch as the opioid crisis and the White House initiative, Endingthe HIV Epidemic: A Plan for America.

While the description sounds pretty good, I wonder how manypeople knew such a program existed. I dug deep and found the budgetfor this specific program, and it amounts to a little over $6billion dollars right now!

When I started to look for the locations of these Health CentersI only found three within a reasonable distance from my home.

I should note that I live on Long Island, New York, which has apopulation of roughly 3 million people.

What I am outlining here is a large expenditure of cash. Maybenot the trillions the government is spending these days, but withvery questionable benefit. Seems like no one in the federalgovernment has really paid attention to all the money being spentin the name of health care!

The daily barrage of information we have been getting from thenews media includes a slew of initials, among them: CDC, NIH, FDA,and CMS, to name a few. Do they have anything in common besidesbeing somewhat mysterious? The answer is they are all branches ofthe U.S. Department of Health and Human Services mentionedabove.

The Affordable Care Act is also overseen by the U.S. Departmentof Health and Human Services.

The annual budget for HHS is roughly $ 1.3 trillion dollars!

Despite the fact that the coronavirus pandemic has made ussomewhat immune to large sums of money, the total budget for thenation of Israel is roughly $ 116 billion in U.S. dollars, so, it'ssafe to say that HHS is a pretty big organization.

Right now, in spite of all that spending, doctors' practices arebeing gobbled up at an alarming rate, as they cannot competeagainst hospital-based medical practices. Hospitals quietly visit amedical practice and make the owners "an offer they can't refuse:"Doctor, you will become an employee of the hospital, and, inexchange, we will simplify your life and pay you a salary."

The net result is that doctors are now on a clock and need tosee a certain number of patients every hour to satisfy theirhospital employer. In the end, the patient suffers as the qualityof care decreases.

If this government agency could be more efficiently run, thereis no reason the government could not compete against privateinsurance companies rather than trying to turn them into elaborateadministration and bill-paying entities.

If, back in 2009, when Barrack Obama was first electedpresident, he had proposed a big expansion of the Health Centerprogram with the goal of giving people a "government option" thatworked, we would be better off right now.

I use the word "option," and my thinking is that, with goodbusiness principles built in from the start, not only would agovernment Health Center option have helped the country get out ofa financial problem it was facing, but it could have also ensuredthe future of generations of American medical professionals.

A new health care center program

My vision has three key components, which could still be adoptedtoday, in light of our current financial hard times.

Step 1: Make use of commercial buildings vacantthanks to the financial crisis that is currently going on. Convertthem into first-rate medical centers that provide more than justprimary care.

Step 2: Outfit the buildings using equipment;office furniture; phones and computer systems that weremanufactured at least 75% in factories based in the United States.This would create employment opportunities

Step 3: Devise a way of competing with thefor-profit health care world for the best medical students.

The current Health Center program website states, "We awardscholarships to students training to become health care workers. Wepay school loans for current primary health care workers.

What if… this part of the Health Center Program was expanded.Let's say it actively competed for the best and the brighteststudents early on in the school career. Say, at the high schoollevel.

Let's say students would be encouraged to follow a career inmedicine at a Health Center. As the program is now arranged, manystudents would not qualify for the aid that is discussed. What ifevery medical provider was told, "We will pay you a salary for fiveyears. If you work for us for that period of time, all student debtis forgiven. In addition, the federal government will back you ifyou decide to go into private practice. We will give you extremelylow rates of interest to outfit an office. For the first threeyears the federal government will provide your malpracticeinsurance at extremely low cost."

If doctors wanted to stay with the federal government program ata Health Center, they would receive an increased base salary, aswell as additional income if they took on a teaching role.

The stigma that is currently associated with the Health Centerprogram might disappear, as citizens started to see the centers asa first-class medical choice for care.

The Health Center I envision would be a soup-to-nuts medicalfacility that would go well beyond providing basic primary care. Itwould be a means-tested, no-exclusions-on-preexisting-conditionsprovider of comprehensive medical care.

We would expand and upgrade the hospitals available through theVA but we could do away with the VA altogether and reclassify it aspart of the national health system. Since the VA hospitals can'thandle all of the load they are already tasked with, more hospitalswould need to be built. But, at the same time, the Health Centerscould take some of the burden off VA hospitals, or the VAhospitals' successors, by providing primary and non-hospital carefor those in need.

Why the new health centers could help

I think that the federal government could be a reasonably goodprovider of medical care for those that want it without scrapingemployer-based health insurance. I also think that for those thatwanted and could qualify for individually underwritten and issuedpolicies those folks could be accommodated through the privatehealth insurance market.

Having a government option as a direct competitor to privateinsurance would ensure that the private guys would try and pricetheir products competitively. With the added benefit ofunderwriting, private companies could price their products to bevery attractive to healthy people and also incentivize some peopleto get healthier to qualify.

Private insurance would be much more attractive to people whowere selective about their medical care while the Health Centerdesign would be more for the masses.

The federal government is in a much better position to be theunderwriter for those with pre-existing conditions and since theHealth center design would be means tested not every dollar of costwould be taken on by the government.

If we adopted this system, health care would no longer be apolitical football, without a final resolution.

This proposal provides a win for everyone which, at the end ofthe day, says a lot.

Jerry Cohen is a brokerin the life, health and Medicare supplement insurance markets. Hisoffice is in Port Jefferson Station, New York.