Civil Writes for Civil Writers
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Civil Writes for Civil Writers PUBLISH HERE
WRITE NOW! Send us Your Prose and Poems and Papers Shredded You've Stuffed in Bottles to Wash up on Distant Shores in the Hope they Will be Seen in the Light of Day! |
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ONE MAN'S MEDICINE by Charles Harris
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THE LAPIUS PAPERS are 100 vignettes of jocund dialogue between two doctors who examine facets of the health care system. Light bedtime reading.
SINGLE PAYER AND HMOs Except for the 37 million who have no Health insurance most Americans have medical and hospital coverage of one sort or another: Medicare for the elderly, has been extended to include those on dialysis, HIV-AIDS and other special cases; Medicaid pays the medical bills of welfare recipients, and the remainder (except for 37 million) are insured by one or another of the numerous Health Maintenance Organizations (HMOs) that flourish throughout the land. Some join HMOs as individuals or as families, others get this coverage as an Erissa by-product of the insurance purchased by the organizations for which they work. The gap between the insured and uninsured has been a noticeable stain on the social fabric of the United States that has been spreading slowly ever since Chancellor Bismarck introduced universal health insurance to Germany about 125 years ago. Some states have tried to remove the stain by allowing uninsured to buy into Medicaid, and during April 2006 Massachusetts passed law that mandated coverage, albeit awkwardly funded, for everyone in the state. Thus it was comforting after these many years to hear President George Bush in his 2007 State of the Union message invite this political wall flower to the dance. He suggested that somehow health insurance of one sort or another ought to be extended to cover all Americans but there the music stopped. Currently New York’s Governor Spitzer is trying to arrange something of the sort. Like a good administrator he started by juggling services to pay for it. To date he’s gotten a lot of people mad at him. But assuming he succeeds eventually, what about to the rest of the country? Because the problem is complex, because opponents are moneyed and plentiful, it is unlikely that a coherent national plan will soon be offered, but there is a short cut to salvation that would provide an adequate stop-gap until a comprehensive Health Care System is developed. Namely to move Primary Care from the HMOs into a Single Payer System staffed by salaried physicians. A Single Payer System limited to Primary Care could be set up side by side with the current HMO structure. Although not comprehensive, the entire nation would with the stroke of a pen have medical insurance for Primary Care. The Congress could fund this on a national level or foist it on the states as partially funded mandates, and derive subsidy from HMOs that no longer would have the Primary Care burden. It could be a great boost for doctors starting in practice and wonderful haven for doctors at retirement age who hate to leave the profession. It would unburden Emergency Rooms to which the uninsured flock often for paltry problems, and it would be a model with which the klutzy HMO system can be compared. Thus HMOs would continue to insure for medical specialties, surgery, radiology, high tech procedures and hospitalization. The Single Payer System would refer to specialists in private practice who were either attached or not attached to HMOs. Referrals would not be restricted to specific panels, an insidious proscription built into HMO contracts that deprives patients of choice and gets in the way of good medical care. Medicare and Medicaid, titles 18 and 19 of the Social Security Act specifically guaranteed patients their choice of doctors, a freedom severely restricted by the HMO consortium. The Single Payer System would honor that commitment. When the government needs space for patients it can rent it from Veterans Clinics, from-not-for profit hospitals (many now in arrears), or create inexpensive facilities in store fronts if necessary. Primary Care has no need for very expensive equipment. It can be satisfied by chairs and desks, good lighting, tongue depressors, blood pressure cuffs, and good clinical judgment. Primary Care single Payer isn’t a cure-all but a first step. For the most part, the uninsured are young and have a low incidence of serious medical problems. Special funding could be arranged to channel special cases into the HMO system. As the parallel systems matured the Single Payer component might be able to enlarge the scope of its operations. Two systems running side by side would give the much maligned single payer concept a chance to be compared by the public with the private insurance industry’s Health Maintenance Organizations and give the government a chance to measure the costs and efficiency of each. In a competitive system competing parties continually strive to improve performance. Currently there is no incentive for this. The tension between single payer and other forms of coverage has long existed, and doctors always made the argument that “socialized medicine” their term for any effort by government to do good, would restrict “free choice.” The doctors seemed to believe that they were the last bastion of free enterprise in this country. Flattered, funded and bolstered in this belief by industry and enterprise they fought “socialization” to the bitter end, only to discover that they had indeed been “socialized”, not by the fearsome government, but by their “friends and allies”, in industry. In the still of the night HMOs sprung up like sunflowers and enslaved the medical profession and patients as well. A Single Payer System side by side with HMOs, even if limited to Primary Care, would give the public a chance to make and vote their choices.
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