Health care and President Obama’s mandate for socialized medicine is something I’ve been meaning to write about for while now, I’ve held off so I can form all my thoughts into something semi-concise and not just a long, rambling, wind bag collection of random thoughts pertaining to socialized medicine in America. There are several points I’d like to make. This is going to be a long one but stay with me for the ride. 
Here I go.
The current state of health care does not work for a good number of Americans. America’s current system doesn’t work for the working poor these are people who make ‘to much money’ to qualify for state assistance (Medicaid), yet their jobs don’t provide them with affordable or decent health insurance. When we look at it from a business perspective the so called working poor are the ones who do all the physical jobs that make life easier for the more affluent people who can afford private insurance so it’s stands to reason that healthier people mean more able bodied people to work.
Our current system of government provided health care (Medicare and Medicaid) systems are ginormous bureaucracies with volumes of rules and regulations that no one seems to really understand. The system is open to abuse and is abused daily by not only patients but the doctors and other people who provide services. We know it’s broken yet no one is bothering to fix it. If history is any indicator, the government will bungle health care for every American not just the relatively few who receive government assisted health care currently.
An example of abuse: My sister who has medicare/medicaid went for a dental checkup. It turns out she has 10 or so cavities. The office wants her to come back for each tooth separately. Now I personally have had 5 teeth pulled in one session, I know people who have had 2 or 3 root canals done in one day. Why would the office want her to come back separately for each tooth? Simple, every tooth is an office visit charge for Medicaid. Instead of one, two, or even three office visits and doing multiple fillings in one session the dentist wants to rake in the office fee 10 separate times. If this is flagrant abuse of the system, I don’t know what is. Who’s supposed to be auditing the billing? Why aren’t they catching straight forward fraud like this? Shoot a computer program should be able to pick up on situations like this. Why is X patient seeing the same dentist 10 times in one year? Does the patient have underlying conditions that require separate visits? If not, then sorry doctor you can longer take medicaid patients. Period that’s it. Scam the system once you’re out.
The problems are very complex though it’s not just an issue of the working poor not being able to afford private insurance. It’s also an issue of hospitals and other providers overcharging private insurance companies because they know they will pay. The common counter to the overcharging statement is that hospitals over charge to cover all the people who use their services and don’t pay the bill. There may be some truth to that but what about charging a fair price to everyone? This way perhaps some of the people who have to pay out of pocket can actually afford it. Instead of charging over $1000 to walk in to an emergency room to receive basic care. How about $200 for a dose of Tylenol and best yet they give you the generic. For $200 I can get a whole case of the brand name Tylenol. How can you rationalize that price? There is no way possible, you just cannot. Please don’t feed me the line ‘well the hospital has to pay to maintain it’s facilities and stay on the cutting edge’. Charge the people who use advanced medical care to stay on the cutting edge. Don’t tell me well you’re using up an ER bed that could be used for someone who needs advanced care, I call bull chit. First of all that’s why pretty much every ER has trauma rooms and regular rooms, that’s why you have triage so the worst patients go first and if something catastrophic happened while I was sitting in a room getting a saline drip and the room was need for someone in worse condition than me, you would pull me right out and I wouldn’t have a problem with that.
The problem also extends to wastes of resources, this takes many forms. Why do we need a phlebotomist to draw blood? Are you going to tell me the same nurse who just stuck an IV in my arm cannot draw a few viles of blood? Are you going to tell me that you cannot save sometime and have the triage nurse take a minute to draw blood if indicated?
Diagnostic tests are another issue a lot of these tests are wasted. Let’s face doctors pretty much guess what’s wrong with you. Wait a second, let me be fair here they hypothesize what’s wrong with you after years of very expensive education. They take your symptoms and run them against a list of probable diseases, infections, etcetera in their heads. Sometimes diagnostic tests just confirm the doctor’s hypothesis but other times a gauntlet of tests are run just to be sure they don’t miss something. More often then not the ‘not missing something’ tests aren’t for any other reason then covering their one arse from malpractice law suits which is sad.
Doctors charge outrageous hourly rates partially because they need malpractice insurance which is mega expensive because there’s no caps on pain and suffering amount. I sincerely believe most doctors are in the business to make people feel better and live a more comfortable life sure the money is an important aspect but I still believe doctors have one of the most noble professions out there. If a doctor makes an honest mistake and it isn’t because they were tired or under the influence of alcohol and drugs the damages should be capped. What the cap should be? I don’t know depending on how bad the mistake was if you can no longer work..The cap should be how much YOU were expected to make for the rest of your career adjusted for inflation and possible promotions. If a doctor’s mistake caused you to lose work or caused you to undergo additional treatments cap it at money lost + cost of additional treatment + nominal pain and suffering.
Capping pain and suffering payouts would allow malpractice insurers to low their rates and in theory therefore allow doctors to lower their fees. As to how this pans out in the real world, we all know how greed people can be.
Here’s what I think we need to do: Utilize more licensed nurse practitioners and Physician’s assistants. In just about every state LPN’s and PA’s have most of the powers of a doctor such as ordering tests, diagnosing and treating you, writing prescriptions, etcetera. Often times these folks have more real world experience then just out of medical school ER docs. Have a 1 or 2 doctors staff an ER with several PA’s and LPNs. The PAs and LPNs can ‘treat and street’ all the non-serious cases. Let the doctors worry about the serious cases and be there to advise the LPNs and PAs IF they need it. I’d even go so far as to say the easiest cases such as idiots who go to the ER for a common cold, or simple upper respiratory infections and stuff like that should be treated right in the waiting room. Heck if the triage nurse were an LPN or PA, they could diagnose, write a script, and get the patient out of the ER without even taking up a bed in little more than the time it takes to do the triage vitals.
Open 24 hour clinics all over the place. By all over the place, I mean clinics should be just as easily reachable as hospitals. They don’t need much more than a few exam rooms, a waiting room and basic medical supplies. Staff those clinics with LPNs and PAs as mentioned above. Allow ambulance to take non-life threatening cases to the clinic. Take some of the load of the hospitals while providing cheaper but competent health care.
Face it, so long as hospitals have a duty to provide care and people don’t have insurance there are going to be people who go to the ER for stupid things that a regular doctor should be treating. Clinics will alleviate the pressure on hospitals freeing them up to care for those who really need a full staff of doctors, nurses, and on demand diagnostic testing.
Now you ask who’s going to pay for this. That’s the 100 billion dollar question. I really don’t think it’s fair that someone who went to college, got a degree, and makes a good living to provide for his or her family should have to subsidize health care for someone like me via taxes. It’s just plain unfair. What about people, even the working poor, who make a conscious effort to live a healthy life style..Why should they have to pay additional taxes to pay for the health care someone like me, a fat guy who smokes? That doesn’t seem very fair or even wise.
My suggestion is this: Instead of lumping everyone into socialized medicine. Let the people who are happy with their current coverage keep it, and not have to pay a dime extra in taxes to subsidize a national health program. Revamp and expand the Medicaid and Medicare systems, set strict standard, weed out the scamming doctors and patients. Now, let average Joe the plumbers buy into the the system instead of saying ‘you make to much money you’re ineligible’. People should be able to buy in on a sliding scale with discounts for maintaining a healthy lifestyle and up charges for living an unhealthy lifestyle. The more you make, the more you pay. Now what happens is commercial insurance can compete with nationalized health care. Affluent people can choose between private and socialized insurance as in theory the prices will be similar for affluent folks.
As for the clinics the need to be built. I’m sure we can slip something in a stimulus package to build them.. Think of all the jobs it will create; perhaps even the government can stop propping up the auto industry under the guise of saving jobs if those clinic building jobs were earmarked specifically already unemployed people.
The whole thing is that the government doesn’t have to make a profit as hospitals owned by corporations do or even doctors with their own practices have to. The government only has to break even with a very small margin of profit for system upgrades. This is how a network of clinics could work, even if you don’t buy into the medicare/medicate program above cost per visit out of pocket would still be nominal. If people don’t pay their bill you take it directly out of their next federal tax return no questions asked this way the system can support and sustain itself.
What are your thoughts? Do you think my plan pans out or make things worse?
