There is a hue and cry in this nation for a national (socialized) healthcare program.  I don’t blame people for making noise on this topic… let’s face it: we’re long overdue for some kind of change, hopefully for the better.

It is a good thing that the S-CHIP program passed recently, providing healthcare to children with almost no exceptions.  My state (PA) has had a program called CHIP for a while, which I believe is the same program.

I wouldn’t be me if I didn’t express curiosity about who was going to be paying for this, regardless of how good a program it might be…

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Our healthcare system is a mess, to be polite.  It did not get this way overnight and it won’t get fixed overnight, if at all.  I’m sure that you’re with me in wanting the system to be fixed.

I do not believe that socialized healthcare is the way to go.  There are a number of flaws in this type of system, as related to me by friends in Canada and England.  Unless the government completely buys out Medicine<tm>, there will still be no fairness.  And let’s face it – the US is not a socialist country, in spite of where the new president appears to want to take it.

National Healthcare tends to fail in cases like access to MRI’s, whereas you can get one in the current system as easy as buying a fat-laden (alleged) burger at a fast food restaurant.  Balance, Grasshopper; all things in balance.

There is another point I wish to see addressed: true equality of physical and behavioral healthcare.  There have been a number of laws passed to assure equality but they were completely flawed from the start.  I know I’m asking a lot right from the start but it’s time to get this all straightened out and if we’re going to do it, we should do it right… all of it.

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Let’s not argue about who has the best system… they all have their strengths and weaknesses and it’s not going to further our agenda.  Let’s think out loud and come up with the best solution for everyone.

By everyone, I mean everyone.  Medicine is not only about the patient.  At this point it involves the patient, the physician, and the insurer.  Whatever solution we arrive at needs to take this triumverate into account.  I believe that the patient has the right to the best care possible, the physician has the right to practice without unreasonable constraints, and the provider and insurer have a right to make a profit.

The only problem is balancing this triangle (he said, as if it were that simple).

HMOs

Forget HMOs.  We are naturally of short memory but let me help you out here: when they started, HMOs promised a very high level of healthcare with very low cost that wouldn’t continue to skyrocket.  What HMOs delivered was anything but a high level of healthcare, at a high cost that continued to skyrocket.  HMOs literally killed people by denying necessary healthcare (and this is before we discuss the behavioral portion).  I know of a person who killed herself in the parking lot of her HMO because she couldn’t get the mental health assistance she needed.  She is one of way too many.

INSURANCE – THE DARK TRUTH

Before I came to haunt this plane, I am told that insurance was something that not everybody had by choice.  It was used mostly to cover hospitalization: doctor visits were cash.  How the hell did we get here?

INDEMNITY/TRADITIONAL

You can still find these insurances around but they’re pretty rare and horribly expensive.  If you can remember waaaaaay back, almost everyone had some sort of Blue Shield plan that would pay eighty percent of the bill, making the patient liable for the remaining twenty percent (up to a certain amount, then they were off the hook).

PPOs

PPOs (Preferred Provider Organizations) were the bridge between traditional and HMO insurances.  You agreed to stay within the insurer’s network and they agreed to pay the claims.  One example was Blue Shield’s Personal Choice.

MEDICAID

What happens when you have no health insurance?  Hospitals will take care of you, filling out an application for temporary Medicaid coverage.  If you are not eligible, you’ll have to make arrangements to pay the bill yourself.

Medicaid is a state-run program and will vary from state to state.  PA used to have a single provider; the claims were sent to the state but administered by PA Blue Shield.  The state got out of the insurance business (to the degree they were in it) and the HMOs moved in.  To the best of my knowledge, there is no non-HMO Medicaid provider in the state currently.

Who gets Medicaid?  You have to be within certain income limits.  Or have no income.  The beautiful thing about Medicaid is that the people get the same quality of healthcare that everyone else gets: there is no difference.

What most people do not take into account is the cost of the Medicaid.  I have no estimate of the number of people receiving Medicaid coverage but as someone who used to be a medical biller, even the numbers for a physician in private practice were staggering.  To extrapolate this is to be very frightened at the total cost of providing Medicaid.

THE WORKING POOR

The unfair element here is that people who work but cannot afford insurance do not get any level of healthcare.  You can work two jobs, not qualify for Medicaid and not get insurance from your employer.  What do you do then?

I had a friend who had a family and was in his mid forties.  He worked his posterior off to provide for his family but couldn’t afford healthcare for himself.  Partially as a result of this, he passed away a few months after I met him.

The price of even low-end medical coverage is insane and certainly not affordable to many.  Since they work, they’re generally not eligible for Medicaid.  This is a huge segment of the population.

MEDICARE/DISABILITY

Traditionally, Medicare kicked in at age sixty-five.  It is also the coverage for people on disability.  Recently Congress got their paws on Medicare.  Surely you know what happens whenever government gets its hands on something, don’t you?  It only gets worse.

There was nothing out of the ordinary here, no sir.  The new Medicare implementation was an unqualified disaster, with people not showing up on insurer roles or just horribly confused about all of the `improvements’ that Congress provided (to their friends in Big Pharma<tm>).  People went without their meds.  Pharmacies tried to help here and there but weren’t getting paid by the insurers.

The implementation was not the only disaster: the plans themselves were a mess.  There were hundreds, they were confusing, and there was no plan that would clearly take care of normal people.  Even if you found a plan that might cover most of what you needed, they’d only cover things up to a certain amount.  After that, you were In Trouble (see Medicaid).

This is but one of the many reasons I don’t want socialized medicine: the government ruins everything it touches.  The other truth is that the plans will be crafted with the `assistance’ of the insurers and Big Pharma<tm> themselves.  Rest assured Congress does not have your best interests at heart, especially with high-powered insurance lobbyists slithering around congressional halls.

I have to cover my wife through my employer because her disability insurance does not cover medication at all.  Even switching to one that does would bankrupt us in two months because they won’t cover the amount of meds that are prescribed.  We’d have to pay cash, to the tune of thousands of dollars per month…

BIZARRE STORIES

I am enrolled with Aetna through work.  For whatever reason, Aetna does not cover chiropractors.  This is just plain stupid, especially in light of their coverage of acupuncture.  My chiropractor, far from being upset, is overjoyed by this type of treatment.  He said he can now take cash and this frees him from Evil Insurance Overlords<tm> and paperwork.

Back when we were transitioning from traditional coverage, the concept of copays appeared.  At first it was five bucks for a visit if you had Personal Choice.  I have seen copays as high as fifty dollars recently.  It would seem that you are paying huge insurance premiums for the privilege of paying humongous copays to providers.  Some would suggest you cut out the middle man and just pay the doctor cash (like they used to).  Hey, that might take the insurance premiums down a bit…

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Insurance isn’t getting any cheaper.  I get mine through my employer but still wind up paying a portion (I know, I know, get a better job).  Every year I have been there the premiums have gone up between seven and fifteen percent.  EVERY YEAR.  The running joke is that I can no longer afford to work for them.  Only it’s no longer funny.

My original idea is to get representatives from consumers, physicians, and insurers in the same room, lock the doors, and don’t let them out until they come up with a system that is fair to all, affordable, and won’t kill people.  If that fails, threaten to throw Sara Palin in the room until they figure it out (her voice annoys me – no comment on her politics).

Thus far that’s my only idea, bright or otherwise.  What can you suggest?

P.S.  Stay tuned for a world-class rant on electronic healthcare records…