HEALTHCARE REVISION
The healthcare system in the USA has become atrocious. Most of the fixes you hear about from the Conservative side center on purchasing insurance across state lines. That's nowhere near the wholesale change that needs to be made.
The status of doctors has varied depending on the era and the culture. In Ancient Greece and Rome, doctors were relatively well received; in the United States during and immediately after the westward expansion, they were not so admired. The emergence of the AMA in the mid 1800s slowly increased the status of doctors until, in the 1950s and 60s, they were among the highest strata and richest members of society. The rise of so-called Health Insurance placed the insurance companies between patients and doctors, and while doctors are still largely admired and their services deemed essential, their status and especially income has taken a hit.
Until the late 70s, it was not unusual for doctors to make housecalls. While they often worked out of a clinic, many also "made the rounds" of patients who could not easily come to the clinic. Either at the clinic or during the housecall, the physician or his assistant might take blood or urine samples to be forwarded to a lab for analysis. And in the clinic would often be an x-ray and/or ultrasound machine.
Today, it works like this: patients must make their way to the clinic. The doctor then sends them, often miles away, to a lab that specializes in bloodwork, then to a separate location that does the imaging work. For frail, elderly, and very ill patients, the mere requirement to go hither and yon is cruel and unnecessary.
Think about a patient with a highly infectious ebola-like disease that is undiagnosed. First they can infect everyone at the clinic, then at the lab, then at the imaging center.
And why is it done this way? For an imagined Soviet-style "economy of scale", a demand by the insurance companies to keep down costs.
We do not have Health Insurance. We have a system in which we pay the insurance company to manage our money and decide, for us, what treatment we should get for the money they receive.
Ask yourself what kind of car care would you get if Auto Insurance worked that way. You pay $1000 a month for the insurance, a $10 co-pay every time you see the mechanic, and maybe $25 for a major overhaul. How often would wipers and belts and spark plugs get changed "just to be safe"? Every minor flaw noticed by the mechanic would get fixed. Sure, that transmission swap only costs you $25 at the time, but how many thousands have you spent in the months gone by to the insurance company for the low co-pay? Nobody in their right mind does "insurance" like that.
Obamacare (the laughably named Affordable Care Act) has a deduction of $6000 a year on the cheapest plan. One can hire a doctor outside the insurance system, a so-called Concierge Doctor, who will make a housecall and discuss your issues by e-mail or phone, for between $2500 and $4000 a year. And with portable ultrascan equipment, almost anything that could be done in a clinic can be done in a housecall, reducing exposure of patients to the diseases of other patients, and if the patient is found infectious, he can be quarantined for the duration, reducing the exposure of hundreds of healthy individuals.
In short, what the nation needs is not single-payer or insurance across state lines, but a removal of the insurance companies for all but real insurance, that is, catastrophic insurance only (and that should be universally required, the penalty for not having it should be reduction of medical treatment by the state to minimum standards; no cutting edge or truly expensive procedures for citizens who abrogate their responsibility to mitigate damages of catastrophic disease). For all non-catastrophic maladies, the burden should be on the individual to pay, either through an insurance company policy, or a medical savings account, a doctor's contract (Concierge), or direct payment to the doctor.
Catastrophic policies could be available with government subsidies for those below certain income levels and as tax deductions for those above, making universality easy and truly affordable. With Medicaid for the poor to cover basic healthcare, and letting the consumer choose his own method of acquiring medical care, costs would be reduced, many doctors would reconsider leaving the profession (as they are doing in great numbers now), more students might consider the career, and quality care would again be the goal, not "economy of scale".
The healthcare system in the USA has become atrocious. Most of the fixes you hear about from the Conservative side center on purchasing insurance across state lines. That's nowhere near the wholesale change that needs to be made.
The status of doctors has varied depending on the era and the culture. In Ancient Greece and Rome, doctors were relatively well received; in the United States during and immediately after the westward expansion, they were not so admired. The emergence of the AMA in the mid 1800s slowly increased the status of doctors until, in the 1950s and 60s, they were among the highest strata and richest members of society. The rise of so-called Health Insurance placed the insurance companies between patients and doctors, and while doctors are still largely admired and their services deemed essential, their status and especially income has taken a hit.
Until the late 70s, it was not unusual for doctors to make housecalls. While they often worked out of a clinic, many also "made the rounds" of patients who could not easily come to the clinic. Either at the clinic or during the housecall, the physician or his assistant might take blood or urine samples to be forwarded to a lab for analysis. And in the clinic would often be an x-ray and/or ultrasound machine.
Today, it works like this: patients must make their way to the clinic. The doctor then sends them, often miles away, to a lab that specializes in bloodwork, then to a separate location that does the imaging work. For frail, elderly, and very ill patients, the mere requirement to go hither and yon is cruel and unnecessary.
Think about a patient with a highly infectious ebola-like disease that is undiagnosed. First they can infect everyone at the clinic, then at the lab, then at the imaging center.
And why is it done this way? For an imagined Soviet-style "economy of scale", a demand by the insurance companies to keep down costs.
We do not have Health Insurance. We have a system in which we pay the insurance company to manage our money and decide, for us, what treatment we should get for the money they receive.
Ask yourself what kind of car care would you get if Auto Insurance worked that way. You pay $1000 a month for the insurance, a $10 co-pay every time you see the mechanic, and maybe $25 for a major overhaul. How often would wipers and belts and spark plugs get changed "just to be safe"? Every minor flaw noticed by the mechanic would get fixed. Sure, that transmission swap only costs you $25 at the time, but how many thousands have you spent in the months gone by to the insurance company for the low co-pay? Nobody in their right mind does "insurance" like that.
Obamacare (the laughably named Affordable Care Act) has a deduction of $6000 a year on the cheapest plan. One can hire a doctor outside the insurance system, a so-called Concierge Doctor, who will make a housecall and discuss your issues by e-mail or phone, for between $2500 and $4000 a year. And with portable ultrascan equipment, almost anything that could be done in a clinic can be done in a housecall, reducing exposure of patients to the diseases of other patients, and if the patient is found infectious, he can be quarantined for the duration, reducing the exposure of hundreds of healthy individuals.
In short, what the nation needs is not single-payer or insurance across state lines, but a removal of the insurance companies for all but real insurance, that is, catastrophic insurance only (and that should be universally required, the penalty for not having it should be reduction of medical treatment by the state to minimum standards; no cutting edge or truly expensive procedures for citizens who abrogate their responsibility to mitigate damages of catastrophic disease). For all non-catastrophic maladies, the burden should be on the individual to pay, either through an insurance company policy, or a medical savings account, a doctor's contract (Concierge), or direct payment to the doctor.
Catastrophic policies could be available with government subsidies for those below certain income levels and as tax deductions for those above, making universality easy and truly affordable. With Medicaid for the poor to cover basic healthcare, and letting the consumer choose his own method of acquiring medical care, costs would be reduced, many doctors would reconsider leaving the profession (as they are doing in great numbers now), more students might consider the career, and quality care would again be the goal, not "economy of scale".