HEALTH
February 2006
In 1993 when
President Clinton appointed his wife Hillary to head a committee to develop an
all inclusive Health Care System, he did not expect a result that would enrich
the insurance industry and exclude 47 million Americans. Most European and Asian nations insure their
citizens with reasonable success, but ironically, the United States, wealthiest
and self advertised as the most advanced nation in the world still harbors 47
million citizens bereft of health insurance. England and Canada have single
payer systems; Germany’s Health Care System inherited from Bismarck over 100 years ago, modified by war and
occupation still serves the nation through an inter linked series of Districts
that form a national pool to which the wealthier contribute monies in order to
subsidize the poor. East Germany when ruled by the Soviet Union had universal
health care. The French enjoy a system similar to our Medicare except that
everyone, not just those over 65 years of age is insured.
After months of
arduous study, Hillary in conjunction with some of the “best” brains of the
Public Health intelligentsia produced 1000 pages of complex plots and plans
that was deemed unworkable and klutzy enough to be turned down by a Congress
dominated by Democrats. Even now, 13 years later, she is derided for failing in
the mission. But she didn’t fail entirely, because the plan became a model and
signal to the insurance industry that a national fabric of HMOs in private
hands would find little opposition by Congress, nor by the Administration, and
certainly not by the insurance industry. The failure of congress to legislate
the Hillary Plan gave free rein to the private sector, which launched the mess
we have now. As things stand, the HMOs,
independent of the government, and draining funds that could better be used
elsewhere, have created an ad hoc system guided by the mantra of Managed Care,
which stands for Best Care for the Lowest Cost, (sort of an oxymoron, isn’t
it?). The HMOs embracing Managed Care immediately bastardized the principle by
establishing set aside funds, a pool of bucks to be paid to the doctor, minus
money subtracted for each procedure, lab test or referral that the doctor
orders. In other words, a monetary incentive or bribe of the primary care
doctor to do less, render less care. Under HMOs and Managed Care the cost of
medical care was supposed to be controlled and restrained. There were no
savings becaue money ordinarily designated for heath
care wne to salary the insurance industry.
In the US the
wealthy can buy insurance, the very poor, the aged and prisoners get it for
nothing. But people unlucky enough to be hard working and not too poor,
sometimes labeled “Medically Indigent” more often than not cannot afford it.
Hospital charges are
so inflated that they invite chuckles of disbelief. But the charges are really fantasies that are
adjusted downward by Medicare and HMOs to a reasonable fraction of the bill.
But the catch is that the uninsured, those who have the least available cash,
must pay the full amount. This burden falls on self employed hard working
people, often tradesmen, blue collar, or people in families holding several
jobs in order to subsist; often the people without whom the country could not
survive.
For years the AMA
bleated repeatedly that
the government was out to Socialize Medicine, and “Socialized
Medicine” was bad because it deprived people of their choice doctors. Doctors
joined the chorus. Surprise! The AMA was right. We have been Socialized,
not by government as the AMA anticipated but by enterprise. And guess what? The
HMOs do not provide a
choice of doctors, except of course, for those in the restrictive panel offered
to the insured patients. All doctors are
not equal, and under the present system, patients are deprived of the
specialists that might best suit their needs.
The public is
disenchanted, many are disenfranchised, doctors are disillusioned,
reimbursement is sluggish, malpractice insurance is high and services that are
reimbursed poorly tend to be discarded. For something as simple as urinalysis
patients are referred to laboratories and costs are out or sight.
But there is a solution. Let the public
choose.
The government ought to establish a Single Payer system, not to replace
the HMOs, but to compete with them. A system that would care
for all citizens rich or poor, the costs of which would be prorated according
to the income of the client. It would be a system to which new medical
graduates might want to gravitate. It
could be attached to the Veterans, the Public Health Service, or some other
agency.
Marketplace
capitalism embraces competition as something that levels the playing field
between buyers and sellers. A Single Payer system competing for patients would
force HMOs to pay attention to patient care rather than costs, and patient care
generally would improve as HMOs develop models and practices that would force
the single payer system to sharpen its medical practices. A “Single Payer
System” competing with HMOS would assure that every American was insured for
Health Care. It would have the potential to provide the best care independent of cost. It
could provide for cross referral between systems to gain certain efficiencies.
It could correct inequities in the present system. Basically the two systems
side by side, Single Payer and HMOs could work as a self correcting homeostatic feedback system.
Hooray for
thermostats and cybernetics.