hudebnik | health insurance again

So we were in Manhattan Tuesday night to visit

la_peregrina and her hospitalized husband, and outside Penn Station we heard bullhorns. As we got closer, we realized it was a health-care protest rally. As we got still closer, we realized it was two health-care protest rallies, a few yards apart. One, most of whose participants were in wheelchairs, was waving signs saying "Medicare for All" and chanting "Nobody out! Everybody in! Single Payer Now!"; the other group were waving signs saying "Mr. Obama, we stand with you in supporting a robust public option" and chanting "What do we want? Health care! When do we want it? Now!" And I suddenly remembered that Obama was in town for some terrorism-related event, which would explain the increased police and military presence on the streets.

So this is how the debate looks in "blue" America: do we go for single-payer, which is simple, easy to understand, and proven to work and save money in dozens of other developed nations, or do we accept that despite all those advantages, single-payer won't happen while even one insurance-industry lobbyist draws breath (because they're fighting for the survival of their industry), and aim only for giving the insurance companies some real competition and regulation that might drive down their profit margins?

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There is no single easy answer, including the 'single payer' option. My best model is still the military one I remember from my days as a military dependant - you went to the base clinics building, signed in at the clinic you wanted to visit, after presenting your ID card. You waited maybe a half hour, then saw your doctor, spending anywhere from a half hour to an hour with him or her, depending on what was needed. If you then had to see another doctor or have something done at a lab, you walked over to that clinic - still in the same building - and had the work done. When that was done, you either went home to await results - usually a call back in 1 to 3 days - or you went back to the original doctor to await results and were called in for a second visit on your original appointment day. Any surgery that was needed was planned right away, or an appointment was scheduled so that you could talk about it with someone else present. You never saw a bill for anything. It was all covered under your ID.

I liked that all I had to do was present 1 ID card for everything, and that it was all in one building, no running around to location after location - even all the pediatric clinics were right there, as well as the retirees clinics. I think the only thing they couldn't handle on-base was major dental surgery - and that they had an off-base clinic set up to handle - and bill the military - not you.

If there was a way to reduce the costs of healthcare across the board, and consolidate all the needs of a community into one place, it would make a lot more sense, far as I am concerned.

That sounds like going a step beyond single-payer to single-provider, which I gather is sorta what Great Britain does (although doctors and hospitals are allowed to compete on the private market if they want, most of them are employed directly by the National Health System. As I understand it; I may be off-base, having never lived in the U.K. for more than a week or two). It's also fairly similar to what the Veterans' Administration does in the U.S. (as opposed to Medicare, which is single-payer but the providers are all private.)

You don't mention how the doctors were paid in the military system, but it may well be that they were on salary, rather than fee-for-service. There's something to be said for that too: it means your doctor doesn't have a financial incentive to do unnecessary procedures and order unnecessary tests, which helps cut costs. I don't know if any of the bills currently in Congress seriously attack the fee-for-service model.

A variant on that approach is the "doctors' cooperative" in which a bunch of GP's and specialists pool their income, so that no one of them stands to gain very much by ordering extra tests or procedures; all of them stand to gain if you're a healthy, happy, satisfied customer. There are a few of these in the U.S., and they do seem to foster both an atmosphere of cooperation and lower total costs.

My brother is actually looking to be employed by one such "co-op" in northern California as a marketer. I rather like this variant on principle, in any case, whether he gets hired there or not.

From what I remember, all the docs, techs and nurses were actually in the military, so yeah, salary rather than pay-per-client. I think a set salary makes things easier anyway.

My point was more that all I had to do was go to 1 place, with 1 card. No running all over to this doctor and then that doctor and making appointments everywhere. I just had to show up. I didn't have to make appointments, I didn't have to get referrals. One place, one card. No problems.

I don't necessarily understand the politics that make this issue so damned hard to solve, but I do know that people don't get the care they need because they can't navigate the system as it is. I certainly hate it all. Even with the 'good' insurance I have through the DOE, its not easy to make an appointment, or get time off of work to go to an appointment, or even get to an appointment when you don't drive.

Frustration is the name of the game right now.

I've been reading your sysnopses of the debate with interest; locally, it tends to get obscured by the political mud-slinging. And now that mud-slinging has spread to the Kingdom mailing list...oh dear...

Just another OT flame war, I take it? I haven't been on my list in some weeks. Too much Life Attacking for me to bother right now.

I'm not in that Kingdom. Aw shucks; missed a perfectly good flame war.

Then again, I'm not on my own Kingdom's mailing list either. Aw shucks; missed a perfectly good flame war.

health insurance again

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