Pat,
Let me respond by saying, that I wouldn't have agreed with ME either, when I first entered medicine so many years ago. Socialized Healthcare was a uniform dirty word for physicians and patients, and the Canadian system might be the very model for some of it's pitfalls. However the current system in this country, while being able to provide the most sophisticated healthcare in the world, also is unable to look after everybody, and lack of access is the most serious problem. (I'll deal with what I think can be very viable solutions in another/later in the post, if that's OK).
Next, overpricing and unavailability of pharmaceuticals is a very glaring problem, particularly for aged folks who need basic meds just to get through each day (I am not referring to trendy new medications with untested/unproven track records, either).
Third, overtesting, overtreatment, and inappropriate performance of surgical procedures is a huge area of concern. Does every headache require an MRI scan? Does every (any) cold need antibiotic treatment? Does every ruptured lumbar disc require surgery? Does all coronary artery disease require bypass surgery?
The bottom line may well be, that since, (with the aforementioned in mind), the co$t of current care, is unaffordable for most, out-of-pocket, the system cannot survive without a broker of sorts, for payment. Hence...Insurance Companies. But, as you know, they may be the root of as yet more evil. Firstly, not everyone can afford the premiums. If you an entrepreneur, own a small business, or self-employed in any field of endeavor (now pay attention all you musicians and artists out there), you may not only be unable to afford insurance, but unable to obtain it in any fashion, barring being able to find coverage under a spouse or relatives' plan.
The coverage is never all-inclusive, there are still out of pocket expenses, and the Insurance companies regulate what they will and will NOT pay for. Medicare is one of the worst systems (yes, I know it's Gov't run, but the federal government has starved it slowly over the years, so rationing is extreme at present), in that regard. Their reimbursements to physicians, patients and hospitals is going steadily downward each year.
Finally, the legal system of malpractice in the US forces an increasingly paranoid and defensive brand of medicine to be practiced here. Physicians will often order tests, procedures, and even surgery, for no other reason than a "C.Y.A." way of thinking. And the costs keep going up, up, up.... So does the cost of medical malpractice insurance; a real crisis at present. Doctors have relocated, stopped training for high risk specialties like Obstetrics (I'm talking legal risk, not medical risk), or if close to early retirement, hanging it up all together.
Do I have any answers? Yes, I have a few ideas. If we are going to have a healthcare system, free of Insurance Companies and Medicare, we are going to have to pay for it. This is not impossible, but nobody seems willing to do that. We feel healthcare is an inalienable "right" (I think that issue alone is an item for further discussion), but don't want to, or are unable to pay for it. In any event, the flicker of hope for paying (yes, actually paying for care), would be dashed by the outlandishly expensive costs for care. We would need less drugs, less tests, less procedures, and less hospitalization to make it work. I think that it is possible, but alas, the inevitable roadblock of attorneys and patients suing doctors (the frivolous suits, not the suits rightly brought forth for charlatans, frauds, patient molesters, and other vermin with the title "doctor", but without the soul and compassion of Doctorem Medicinae). So, unless we patients, physicians, pharmaceutical companies, and hospitals are willing to bite the bullet for a few years in order to bring affordable excellent care (but avoid overcare, and wasteful care), that we pay for OURSELVES, we are stuck with:
1. The continuing evolution (really de-evolution) of the current system (which will bankrupt itself anyways...this I can GUARANTEE you, eventually will happen). Here, I include all : Private Insurance (fee for service), HMO, PPO, and their various mutations, Medicare, Medicaid.
OR...
2. A National or State "provided" inclusive healthcare system. This, I can GUARANTEE you, is inevitable, in some form or other.
The only roadblocks to choice 2, are the powerful Insurance Company, Pharmaceutical, and Trial Attorney lobbyists in this country. It won't make much difference if it is a Republican or Democrat admin, by the way. The Insurance Co's, and Industry do better with the Repubs, but the Trial Attorneys fare better with the Dems.
Do I think National Healthcare system is ideal? NO. It will be a doorway of opportunity for mediocre and rationed care, BUT everyone will get care, and there really should be no excuse for not getting excellent care. Just don't expect all the bells and whistles, which, truth be told, are not necessary anyways. The rich would still get their Tummy Tucks and Tushie Liposuction, by paying out of pocket (they do now).
Conscientous Physicians, and other providers (who remember from time to time why they went into their careers in the first place), will still be able to practice excellent medicine; unfortunately, some will choose to slide, hence the potential for neglect under a rationed system. It won't be perfect.
I am already working in what I firmly believe will be the ideal prototype for a National system. I have been a physician with the Veterans Admin for 5 years now. I can honestly say,my veterans get as good (I think BETTER), compassionate and scientifically/technically advanced healthcare as in the private sector. Yes, we have formulary restrictions on certain medicines (and the reasoning is more than fiscally sound, it is also scientifically sound), you don't get rushed off to surgery inappropriately, and MRI's aren't ordered just because the "schedule needs to be filled...we have to pay for the magnet". Yes, there are "waiting times", not service on demand for elective or scheduled visits,(private sector also), but emergencies/urgencies are treated in a state-of-the-art emergency room, by top notch ER physicians, just as in most community ER's across the country. Most of my Veteran patients feel they have never had better care than with us.
I foresee this as the first possible entree into a National System: The first step (and this has been discussed in Washington), is to expand Veteran services to include family members of Veterans who are currently receiving care in the VA system. If this works, and I cannot see how it could not, the transition to the system for the entire population would be very forseeable.
How to pay for it? Yes, taxes..but some redistribution of current tax structure could take care of a significant portion of the increase. The current wage-earner contribution to Medicare would certainly be shunted towards this. I would like to see a portion of Defense Expenditure go towards VA and family of VA members' healthcare if the VA healtnet expands, like I suggested above. Same for DOD, and their immediate family.
What about tax incentives for Preventive Care? Folks who don't utilize BECAUSE they are healthy OR because they are taking concrete steps to improve their health should be rewarded. This could take a tremendous burden off of system utilization.
Examples:
1. Credits for Quit Smoking, and stayed Quit, whether self-initiated or through completion of a smoking cessation program (documented by voluntary urine testing).
2. Credits for Exercise program(s),where such programs have a documented course of achievement, and record of attendance by an instructor or trainer, including measurable parameters such as: lowered cholesterol, lowered Blood Pressure and Heart Rate, glucose control, Basal Metabolic Rate, Body Fat..etc..
3. Credits for : Walk to Work(School, Shop, Studio), Ride Bike to Work, Cross Country Ski/Skate to work (for all you dudes/dudesses from New England, and oh yeah...Kevin G in freezing Minnesota).
4. Credits for Anger Management, hugging and kissing your kids and Parents, being super kind to animals, and yes, helping elderly folks cross the street etc..
Yeah, I know I'm getting expansive here. I'm also getting writer's cramp. Gotta go...coffee break's over, and I gotta look after my Vets. (They "lost it all for me, there must be SOMETHING I can do..." for them).
See ya' Pat. I don't have the "answer"..just some ideas.
Gene
