SINGLE PAYER
Summary
This innovative system (without disturbing the
HMO Care programs) will:
1. Assure
availability of Primary Care Medicine for all citizens
2. Decongest ER
and add those patients to the single payer primary care system
3 .Provide
primary care nights and week ends for all
4. Lower
Health Care costs for:
a.
Families
b.
5. Provide
medical nodes nation-wide to support service for Terror inflicted wounded.
6. Boost
employment significantly
7.
Put Primary Care facilities into empty Mall space
8.
Curb the HMO penchant to raise rates
9.
etc. etc. etc.
Except for the 37 million who have no Health
insurance most Americans have medical and hospital coverage of one sort or
another, much of it Single Payer: Medicare for the elderly, has been extended
to include Addiction, Dialysis, HIV-AIDS and other special cases. Medicaid pays
the medical bills of welfare recipients; Veterans are served by the U.S.
Department of Veterans Affairs; Native Americans by the Indian Health
Service; and the remainder (except for
37 million) is insured privately 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 byproduct of the insurance purchased by the industry, enterprise
and other businesses 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, (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 by suggesting somehow health insurance of one sort or another ought to be extended to cover all American. But that’s where the music stopped. For a brief moment New York’s ex Governor Spitzer had Health Care in his sights, but soon he himself dropped out of sight. Nonetheless, Health Care Insurance may be the buzz word of 2009.
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. In 2004 37% of all physician office visits were to
offices of Primary Care physicians. This figure does not include visits by the
uninsured to the Emergency Room, or visits during nights and weekends by
Insured individuals who, unable to locate their physicians were forced to go to
the Emergency Room.
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.
HMOs would continue to insure for Consultation in
medical specialties, surgery, radiology, high tech procedures and
hospitalization.
When necessary Doctors servicing The Single Payer
System would refer patients to specialists in private practice best suited for
specific ailments, whether or not they were 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.
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 choices
and vote for them.
GUESS WHAT?
When I first envisioned this system
described above I had no idea that it actually EXISTS in the form of Primary Care
Centers created by Grants from the HRSA (Health Resources and Services
Administration under
I have placed Hard Copy of this
information on the desks of every Senator (100) in the
It is ludicrous that Senators and
Representatives should argue back and forth about support or no support for a
system that has been in place for 50 years. The Congress actually funds them.
HOW CAN THE CONGRESS VOTE FOR OR AGAINST A SYSTEM THAT IS
It seems that the current “cure” is
to force all Americans, namely the young who feel they do not need Medical
Insurance to buy it in order to bolster coffers of a failing system. That is
obscene. Expansion of Primary Care Centers will, on he other hand, lower costs.
www.primary-care-medicine.net Back