Monday, November 16, 2009

Universal Health Care: What it Should Contain

Many patients and friends have asked me during the past months what I would like to see in universal health care. I only want a system that is best for my patients, and takes the least paperwork time for me. Any system, of course, will always pay less for thinking than for doing (i.e. operating) because it is difficult to measure thinking. I defer the question of outcome measurements to another blog.

1) We already have socialized medicine, and it is called Medicare and the VA Hospitals, and none of the users of the systems seems very much dissatisfied with it. And, in fact, middle-class parents paying to put their children thru college, etc., would find it difficult if not impossible to provide dollar for medical dollar coverage for their elderly parents, as they would have to do without Medicare.

2) You are allowed (by law) to keep your same cell phone number for life, if you want to, and don't have to change it every time you switch carriers. But when you are transferred from HMO A to HMO B because your company got a better premium deal from the second company,you suddenly have to scurry around and find a new internist, gynecologist, pediatrician, and any other specialist you are seeing. This is manifestly unfair, inefficient, and disrupts the smooth flow of medical care-taking. It's one thing if a patient chooses to leave a doctor, but to be forced to leave a doctor is unconscionable and stressful. And what if you are a Cigna patient but the world's expert is an Oxford surgeon? Then you have to pay his full bill, with no insurance deduction. You should be able to KEEP THE SAME FAMILY DOCTOR FOR LIFE!

3) Many patients are tied to their jobs thru their health insurance. If they stop working or switch their jobs, their wife and children may not be covered, or there may be very special coverage available only while they work for this particular company.

4) A minor point: why does the family coverage for your children stop when they are 23 years old?

4) A stronger point: If you and your wife both have paid premiums for a $100K fire policy on your house, and it burns down, you both get paid $100K., because you each have a policy. But if you and you wife both have paid medical premiums for a family policy, and you get a heart attack,you can only collect doctor and hospital bills from one of your policies. This means the other one was invalidated for this case, and all the premiums (10, 20 30 years' worth)are sheer profit for the company. Why should this be? It's like reverse double-dipping,only this time your pockets are the ones being directly dipped into.

5) I should not have to waste my time calling up for permission for MRI's. I don't have to do it for MCR, but most HMO's want me to expose a patient to cancer-causing Xrays of a CT exam before they allow an MRI, or I have to spend a lot of time (my least fungible recourse) convincing them otherwise.

6) I could also save time if I didn't have to call the drug management company to explain why the drug I chose for my patient is preferable to their chosen (and cheaper) drug. They don't know the patients. (Actually, must drug stores and wholesalers make a greater per cent profit on generics than brand names, because no one outside the field knows how cheap it is to make a generic.)

7) They should not make Electronic Medical Records mandatory until they have proved that they save money, or at least patient morbidity. There has been no clear evidence of this yet.All I know is that in the "good old days" I could admit a patient and write a set of orders with pen and paper in 5 minutes. Now with filling out the matrix in the computer form in the sequence of questions they ask me (e.g. what is my patient's flu vaccine status, a fact I always put down in my admitting note) punching in my date of birth xx-xx-xxxx (not a code) just more information collected, so all doctors tend to be born on 11-11-1911) it takes me at least 25 minutes to admit a patient. This is not progress, but more on the EMR on another blog.Sometimes when I get tired of all the pettifogging, if it is my personal patient, I just put down patient refuses".

In summary: keep the same doctor for life, and also solve the problem of who will pay for abortions, because as long as we have both men and women, married or unmarried, we will have unwanted pregnancies,

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