By Mark David Blum, Esq.
(*Part on an ongoing series of essays on what should be part of the discussion of the nation’s health care crisis; respectfully named for an actual medical diagnosis).
To construct a national health care system, let us start with a clean slate. Our present system does not have the luxury of doing so. But we here in fantasy land have the option of starting with a clean slate and from there, constructing a medical system that meets the needs of everyone. Maybe it is an inherent and fundamental flaw in my understanding, but the solution seems obvious and the model is right in front of our face.
Starting from a clean slate, I recommend we fashion our health care distribution system after the military model. In a nutshell, the military model starts with a central hospital, then breaks down into smaller field hospitals, battalion aid stations, and the individual unit medics. Each entity, from the hospital down to the medic’s utility belt is a kit. Minds smarter than I sat and decided that for a hospital; so much staff, equipment, supplies, and drugs are required – everything from the number of wheel chairs to the Chairman of the Board. There is an itemized list that must be provided for each and the list is respected and inspected.
It seems to me that our current medical delivery system could easily follow the same model. If we accept the fact that everybody is entitled to medical care, to have pain alleviated, to be treated until cured, and eased into death. No human being should be allowed to suffer against their will. The same minds that determine the number of schools are required for any given population or the number of operable fire stations and equipment are the minds that should determine how many hospital kits should be distributed and where, how many urgent care and outpatient clinics need to be in the secondary market, and of course we need emergency responders.
Funding for these kits should come from taxpayers. Like education, we all need some form of medical care. Hence, real property taxes are the proper funding source since everybody contributes as a part of their ownership or rental amount. The few homeless can benefit from largesse of the remainder. In building these centralized medical distribution systems, the paperwork and most importantly the insurance completely evaporates from the calculus. Only a small portion of the money saved by individuals in having to pay for health care insurance would be applied toward taxes.
Under these proposed kit scheme, anybody needing care can approach the hospital or one of its related clinics and seek treatment. No reason prevents patients preferring a specific physician but the physician is an hospitalist. There is no need for insurance forms, no need to record keep beyond that which is necessary for treatment, and no billing after the fact. Medications should also be dispensed in this fashion.
This plan provides for 100% full care for all patients. No insurance company is dictating what must or cannot be done for the patient. The kit is there and fully supplied.
But what about the doctors?
Those who affiliate with the hospital and become part of its outreach clinics should be compensated at prevailing market rates. Doctors who want a license from the State and want to practice medicine in the State should be required to dedicate a certain number of hours or patients to the kit hospital or its clinics.
I am not even asking the doctors to do what we lawyers do. No doctor is being asked to work for free. But if a physician is going to opt out of the “system” and start his own practice, he not only has to compete with the distribution system in place but is required to do X amount of work at State rates. Lawyers have to do pro bono work as a condition to practice our profession. Doctors can do it too.
Obviously this is a very simplistic presentation and as always the devil is in the details. But anything has to be better than having an insurance company defeating competition and driving up the costs of medicine threefold again.
Recently, the State of Hawaii ended a 7 month experiment providing health care coverage to all uninsured children. The program was ended because it was found parents were cancelling private insurance policies so as to enroll their children in the public plan. Obviously, Americans can look at this experiment as showing that a system that ignores the animal called insurance, and just treats the patient in front of them is preferred.
Under our present system, it is mostly folks with insurance who are using our hospitals, our Emergency Departments, and our clinics. A recent study found overcrowding in ERs is caused by folks with insurance. People without insurance go without treatment or care. It simply costs too much and takes too long.
Yes, there are going to be communities and regions out there that do not have the resources to fund a kit or are too widespread such that kits are needed for lesser populations but for more locations closer to home and easier to access. That problem is solved both by malleability of the kits and the pockets of more affluent communities. Rural South Dakota deserves the same quality health care as does Beverly Hills.
Moreover, nothing is wrong with having a parallel system of private facilities and practitioners for those who insist on paying more for the same product. Nothing should stop a community from providing more kits or more services than a generic kit for the same reasons there are basic civil rights we all enjoy but nothing stops a State from providing greater rights for its’ citizens. That same originalist thinking can be applied to how medicine and care is distributed throughout the nation.
Ours can be a world class system if we remember our nation’s basic fundamentals. Should an American standing on a corner be robbed, a socialized police force come to help. We have a socialized criminal justice system and prison system to deal with threats and wrongdoers because at any given time, any one of us could be a victim of a crime or civil wrong and need help.
If your house is burning down, again we have a socialized fire rescue agency to come and help. Again, we do this because we all realize that any one of us could be at risk of fire and we provide this service to all for our own protection. If your child cannot read, then we have a socialized educational system because we all realize the value of an education and how it betters the nation. If we need plumbing, roads, plowing of snow, we have socialized infrastructure to help everyone because we realize that as a community we need to be able to move about.
But, if you are standing on a corner and you see a fellow American drop to the ground suffering from a heart attack, there has to be more than just standing there saying, “boy, I sure hope he has good insurance.” This is not my vision of the country or the concept of being “American”.
Health care is a human right and one we all assure each other.
I disagree with any policy that mandates the intervention of a third party payor into the equation so long as that payor has any say in the treatment or care of a patient / insured. For this reason, both the McCain and the Obama plan are equally fatal as one or the other involves mandatory insurance or incentives therefor. We simply need to cut to heal and insurance has to be the site of the first incision.