Last week, I outlined a simple and original proposal to better health care access and delivery in America. It was first reported by Steve Lopez of the Los Angeles Times and then in my own op-ed here on the Huffington Post.
I am pleased to acknowledge a tide of public support for my simple and tax-free prescription to solve health care's ailments. I am also pleased to report that as of today, Sunday, August 16, 2009, Congress and the Obama administration seem to have acceded to political pressures and the torrent of dissent by Americans who reject a government "public option" with the potential to nationalize parts of our uniquely American health care system, proudly developed by our country's spirit and ingenuity over the past century.
For background, please refer back to my proposal, which with five bullet points corrects the inequities of the insurance system while preserving the best level of choice and care for all Americans, including the indigent and illegal aliens residing in our country, and with no additional debt or taxes.
Some commentators questioned my plan to mandate that the 159 urban medical schools in the U.S. -- remembering that "school" is in their name -- be required to serve the population within their shadows first, and not ever shut their doors or dump indigent patients to private practice. I would like to point out that although medical schools have markedly reduced professional "overhead" because of medical students working for free, and residents working at marked discount to private practice, this is all carried out under the supervision of excellent faculty, with some working as clinical professors with no compensation, in order to bring the highest level of care to any patient without regard to their ability to pay.
This altruistic vision for the 159 U.S. medical schools can be facilitated by proper mandates and federal regulations, and the schools can deliver great wide-spectrum ongoing maintenance and preventive care, not just crisis intervention. Just look at the model of our Los Angeles County/USC (LAC/USC) Medical Center, which renders 750,000 clinic visits for all specialties and 39,000 in-patient managements per year, mostly for indigents and illegal aliens of the greater Los Angeles area.
Another question raised by respondents to my proposal, the care for indigent or illegal alien populations in rural areas with less propinquity to medical schools, can actually be addressed with same methods now in place; namely, well-performing clinics, functioning under existing Medicare and Medicaid programs. This was highlighted by President Obama in Colorado Springs Saturday. But note that in some instances, patients in rural settings, regardless of their insurance coverage, will be referred out to larger urban medical school centers because of the severity of their medical problem.
The important point is that the huge urban indigent and illegal alien population in this country can get the best and most specialized care available in the US, not the lowest common denominator care, via the re-emphasized and capable medical school model.
President Obama has used the Cleveland Clinic and Mayo Clinic as examples of models of efficient health care, but these systems predominantly serve private patients. I would invite President Obama or members of Congress or the national media to visit the model of the LAC/USC Medical Center, where stellar care is cost-effectively delivered to hundreds of thousands of indigent and illegal alien patients, year in and year out.
Please read my original plan here, I welcome any and all feedback.
Away with the MCAT, away with USMLE, away with Board exams, get rid of medical boards ... we need free healthcare, it doesn't have to be a BMW - a Kia will do.
We lag our peers in MD/patient ratios. How about med schools that don't take 10 years to turn out a doctor? How about specialist MD programs that turn out an MD with GP skills, and not pre-surgical skills? How about getting rid f the rediculous pay and hours that new MD's face?
They could have FREE tuition, paid for by federal govt, and agree to serve where they are needed for a period of say 5 years before they can relocate? It works for France...
When I worked at Mt. Auburn Hospital and found out as an administrator making in the $40K range and earning MORE than MD;s I realized just how screwed up every aspect of our health care is.
Here is a way to fix healthcare along the lines of this blog: 1. Have my neighbor read the internet and prescribe. Treat thy neighbor as part of community service. Remove medical boards, the DEA, FDA and then everyone can have free care, free testing, free imaging. I'll read my own MRI with an online course. Who needs doctors? Just give me the money and I can provide myself my own care with a certificate training program. 2. Remove the rigorous requirements and testing that doctors go through, allow everyone to prescribe and order tests when they need it through the internet.
That is just as ridiculous as his solution to healthcare.
is: BAN ALL CORPORATE LOBBYING AND CONTRIBUTIONS
TO POLITICAL CAMPAIGNS.
The " free speech" garbage about the above is just PROTECTING BRIBERY.
The MESS we've got now has to do with CHRONIC BRIBING OF POLITICIANS
who serve ONLY corporations who pay for their election campaigns.
They DO NOT SERVE THE PUBLIC at all.
THIS IS THE SHAME of AMERICA!
http://64.203.97.61/SolutionsLab/Solution.aspx?Guid=2d50363e-00be-44e8-9251-9a6589ba820d
The student service model works only if enough people have insurance to NOT need to rely on the university hospital. If this weren't true, then why did people have to camp out in Los Angeles last week to receive free medical care during the Remote Area Medical Foundation event.
Its "altruistic" to force tuition-paying students to work for free? Caring for the indigent is society's responsibility; why should the burden fall on students not taxpayers.
And the rest of your "plan" is every bit as dishonest and amoral. Its nothing more than legislating everyone pay insurers. It does not, however, require that those insurers provide healthcare. And modern insurers ARE NOT in the business of providing healthcare. They are in the business of selling healthcare they WILL NOT provide.
Once upon a time insurers were managers of statistically broad pools of unknown risk wherin everyone contributed equally and had equal chances to benefit.
Not anymore. Modern insurers use actuarial tables, statisitcal analysis, modern diagnostics and legal maneuvers to scientificly design policies that WILL NOT pay out. The anomolies, the outliers, the MISTAKES are when they actually have to pay claims.
And THEY are who Dr. Toffel champions. Not the uninsured. Not even the insured. The INSURERS, thats who benefit from Dr Toffel's smoke and mirrors. EVERYBODY else loses.
And for those who simply cannot be milked by insurers, we can exploit students. Because the public will LOVE not having to pay for it. And when those students become DOCTORS expecting seven-figure salaries because of all those free procedures they had to perform as students -- Well the public's STUPID. They believe in something-for-nothing and will never notice its really pay-now-or-pay-later. They never have.
Instead the schools are paid and the students are actually charged fees for the privalige of working for free.
You are the one hiding behind semantics. Clinical training means actually working at the trade. Yes, closely supervised but still performing valuable work. Let's take the market value of their work subtract the cost of instruction and PAY THEM the difference. What's the problem with that?
Not one of your points is a reason not to pay people for their work. Not ONE is a justification for exploiting them. If "that's the way its always been done" is the best you've got we'd STILL have slavery with that kind of thinking.
5) The open door policy would be a good one, however, this still does nothing for one of the largest costs in medicine, the tests and medicine themselves. Why is it a hospital can charge upwards of $75 for a tab of aspirin or $1500-$2500 or an MRI while others charge 10% -20% of that?
You touted your plan as simple and tax free, which it is. The issue is that the problem in health care is not simple and you will not find a simple solution to it. You ignore greed as the major motivating factor in all these costs and assume that the people at the top in control of the money will open the gates and allow all this money to flow down. As evidenced by 30 years of trickle down economics they do not.
1) opening up to cross country insurance will only ensure that the top 5 or 6 companies survive, as seen with everything else in the "free market" the largest buy the smallest to stop competition.
2) Limiting fees without putting a regulated cap on pay will only mean that they will squeeze out more of the "unprofitable" clients. Those with pre-existing conditions or those who are older but do not yet qualify for medicare
3) You assume that employers will give pay raises to the employees. This is absurd since they are only mandated to ever pay a paltry minimum which is a full 1/3rd below the poverty line. Since this is now a employer's market they can just let someone go who wants/demands a raise and hire someone else who wont, and then remind everyone why they let the other person go. It was stated that employers pay like $30k per person for health care, do you really think that they will give that entire amount to the employee as soon as they do not have to pay it?
4) Tort reform did not succeed in California, just like it did not succeed in Texas, it is only 1-2% of costs. How can you claim success when premiums rise every year 10%?
cont...
it might show you why there are many concerns about what kind of care medical schools are providing
http://blogs.sfweekly.com/thesnitch/2009/06/republican_senator_wades_into.php
http://www.sfweekly.com/2008-04-09/news/whistleblower/
http://www.consumerwatchdog.org/patients/articles/?storyId=10628
http://www.signonsandiego.com/uniontrib/20051225/news_1n25hospital.html
http://www.newu.uci.edu/main/article?slug=ucimc_administrators_ignored_federal69
please address these issues before you make the kind of proposal you suggest
http://blogs.wsj.com/health/2009/05/14/grassley-ups-total-of-undisclosed-fees-paid-to-prof-by-glaxo/
along with many more...