The first one, from the Bradenton Herald, is headlined Medicare in crisis: Doctors poised to drop patients. The second one, from the Sarasota Herald-Tribune, is under the headline, For international calls the doctor is in the house — and talks about “concierge medicine” available only to people who can afford to pay a retainer of $1400 or more per year to have a personal physician on call all the time. So we’re looking at better (or at least more service-oriented) doctoring for the rich, and less doctoring for the poor. I’m okay with that. In fact, back in 2004, I wrote a piece about how we can have affordable, universal health care while still giving The Rich all the fancy doctoring they want (and can afford). I think this is a good time to reprint that article, so here it is:

A radical health care proposal

The U.S. health care system is sick and getting sicker. Here in Bradenton, one of two local hospitals has stopped delivering babies because half of their OBs took “early retirement,” theoretically because of high malpractice insurance premiums. I notice, though, that these poor MDs could afford to take early retirement, which most Americans can’t. It’s time to break our dependence on MDs and train more LPNs, Physicians’ Assistants, and other civilian equivalents to Army Medics to handle primary care.

I would be satisfied with clinic-style “impersonal” health care. I have Type II Diabetes and mildly high blood pressure, both controlled by medication. Every six months or so I get my blood sugar and blood pressure tested and my (generic) prescriptions rewritten. When I was in the Army they wouldn’t have wasted a doctor’s time with this sort of routine care. They would have had a Medic look at me and draw my blood, handed me pills from the dispensary, and sent me on my way.

Today, as a civilian, when I go to the doctor a nurse takes my blood pressure and a technician draws my blood. The doctor looks at me and chats, and he’s a nice guy, but he’s the most expensive part of the system — just as expensive as the drugs, which I must get from a separate business that will only sell them to me if I have a note from the doctor.

If I get sick outside of office hours, my doctor’s office tells me to go to the hospital emergency room, where I get assembly-line, clinic-style treatment anyway.

Give me low-cost “sick call” clinic care (and a corresponding break in health insurance costs), and I’d be willing to sign a waiver stating that if they made a mistake I would accept a moderate settlement, plus a reasonable amount for pain and suffering, instead of maintaining my “right” to sue for multiple millions. I’d also prefer not to be resuscitated if my brain flatlines, and I do not expect organ transplants or other extreme treatments; if my body breaks down that far, load me up with medical marijuana or opiates and let me die in my own time, with as little pain as possible, instead of consigning me to the hell of long (expensive) surgeries and hospital stays.

What I’m looking for would cost so much less than the current system that we could afford to give it to all Americans (perhaps with a nominal aditional fee/tax from those of us who can afford to pay, based on income) without driving our government broke. We would have no more people wandering around without health insurance. Everyone would be able to get care, just not fancy care, and those with higher treatment expectations would still be free to pay for more inclusive insurance — or pay out of pocket for any level of treatment they could afford.

Two major holes in our current system need to be plugged to make this feasible: First, we need to have all the (presumably government) clinics take bids as a group from drug companies, and stick to generics virtually all the time. Second, we need to make it legal for people without medical degrees to perform many functions we now reserve for doctors. For example, we need to see nurse/midwife deliveries become the rule, not the exception, and expect to be seen by LPNs or Medics instead of doctors for most ailments or minor injuries, and have pharmacies accept prescriptions from LPNs and Medics, not just from MDs.

No doctor would be forced to work in the clinic system. Many would probably choose to do so because it would free them from administrative headaches and allow them to concentrate on challenging cases instead of seeing endless patients with the sniffles — and would free them from the burdens of malpractice insurance. Other doctors could maintain private practices and charge as much as they wanted, assuming they could find enough patients willing to pay extra for their services to make private practice profitable.

We Americans all seem to believe we deserve the attention of top graduates from Hopkins or Harvard. There aren’t enough of these “prestige” doctors to go around, and there never will be unless we slap a Hopkins or Harvard “brand” on every medical school in the country — and declare that all graduates from these schools are, by law, in the top half of their class. The reality is that most doctors know their business no matter where they went to medical school, and that two-thirds of what they do could be done by people who didn’t go to med school — which is an expensive education because all the instructors are doctors themselves, who want salaries just as high as other doctors, which means the doctor business is locked in an endless inflation cycle because most young doctors coming out of medical schools staffed by expensive doctors graduate with huge debts hanging over them, which means they need to get high salaries.

And heroic life-saving measures… Yes, my neighbor whose doctor says he needs a heart and lung transplant to live much longer is a nice guy, but doing this Medicare-paid surgery will cost as much as providing routine care for 100 less-sick patients for 10 years — and my neighbor knows it and isn’t sure he’ll accept the surgery even if a donor is found (which is not very likely; he’s resigned to the fact that he has a limited time to live and is traveling a lot, seeing all the places he always wanted to see, living literally as if each day might be his last).

Death is inevitable. I can stop smoking and jog 10 miles every day, and sooner or later I will die anyway. Nor can medical care prevent death. It is only a delaying tactic. No matter what we do, some people will live longer than others, even if everyone gets perfect health care from top-grade MDs in hospitals equipped with all the latest diagnostic and surgical equipment.

This may not be fair, but it is the way things are. We need to learn to accept death as inevitable. Once we do, we can think of health care differently — and develop an affordable, universal health care system.

This entry was posted on Tuesday, January 8th, 2008 at 3:25 pm and is filed under Bradenton/local, Business, Politics. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.