Obviously, solving our healthcare woes is way beyond my pay grade; however, the exercise is mentally stimulating.  If the goal is providing healthcare for all, no matter how I redesign the healthcare system, all solutions seem to lead to socialism, an outcome that cannot be tolerated.

If you accept the premise that healthcare will be meted out based on the individual’s ability to pay for it, then other options exist.  If a minimal standard for access and care is established and provided by government clinics, then there is room for a private, pay for service, system to coexist.  Certainly, the inequality of the two systems will cause a public outcry and be advantageous to the haves, increasing the rift between the haves and the have nots.

No matter how you look at it, either system will require the elimination of third parties who siphon healthcare dollars off the top, generating massive corporate profits and sending healthcare costs soaring into the stratosphere.  As I have previously discussed, during the early years of my practice, healthcare costs were far less.  A school physical was $5. Today, an office spends more than $5 on EMR input, billing the insurer, the patient, and malpractice coverage.

The difference between the early years and today are many.  One of the major differences is who paid for the visit and who the contract was between.  In the early days, the patient was responsible for paying the bill at the time of service as the service was between the patient and the physician.  The patient then sent the receipt to his insurer who addressed the bill according to the contract the patient had with the insurance company.  The physician and insurance company were not contracted for the patient’s service. Each patient contracted for different deductibles directly with each other and the physician charged reasonable fees for his/her services for the area he/she practiced in.  The patient fought it out with the insurance company if the full cost of the service wasn’t reimbursed to the patient.  

Today the physician has the contract with the insurance company.  The insurance tells the physician how much it will pay for a service.  That doesn’t mean they are paying what it is worth or what it costs to deliver that service.  It just means that is what the insurance can get away with paying in this day of discounted fee for service medical care.  Generally, it is less than what it costs the physician to provide the service.  In addition, most policies now have very high deductibles that put more and more of the burden on the patient as out-of-pocket costs until that catastrophic limit is reached.  Thus, many office visits are effectively self-pay and this causes people to put off going to the doctor, sometimes with bad consequences. Unfortunately, the bottom line is that we are getting less coverage with far higher premiums.  You are paying more, insurance companies are paying physicians less, and the insurance executives come out smelling like a rose.

Can you fathom how expensive auto insurance would be if it covered every part on your car?  Imagine you need windshield wipers, brakes, a new transmission and tires.  You tell the auto shop, “just send the bill to Blue Cross.  They cover everything for the life of the car.”  That level of coverage would cost thousands of dollars a year.  On top of the owner’s cost of insurance, the mechanic would have to raise his fees to cover the expense of dealing with the insurer.  Rates would skyrocket.

So, maybe the answer is a two-tier system: one for the haves and one for the have nots. One government run one and one based on “major medical” insurance with, as in the old days, the patient contracting with the insurance company and directly paying the doc.  By eliminating the doc/insurance company contract, office overhead would dramatically fall and savings could be passed on to the patient. 

We accept the inequality that exists between the haves and the have nots in every other aspect of life.  A roof over your head and sustenance should be just as much a human right as healthcare; yet we accept the inequalities that exist in housing and living expenses.

Of interest is my experience with Concierge Medicine (contract between doc and patient).  Many of my Concierge patients were in the have not segment of the overall population.  They put medical care in the same category as food and scraped together enough money to pay for it. Not one patient ever expressed a regret. 

It appears that either we accept the inherent inequality of a two-tier system or accept socialism.  Neither sounds like a good choice.  What would you suggest?

Here’s your music and a joke.

If I had a dollar for every time socialism was successful, I’d have zero dollars.

Which is funny because if it did work, I’d also have zero dollars.

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  1. Are those the only two choices? Into which category would you put Medicare for All? I’m not convinced it’s quite so black and white (ie: two choices). I think of socialism as a system of government…not necessarily a term for provision of healthcare. I believe there ARE democracies that offer universal healthcare. I have Canadian friends who are quite satisfied with government provided healthcare.

    1. I had Canadians who came to see me as they couldn’t get the care they needed in Canada. Of course there are all kinds variations of medical care but the two I presented are the basis on which all other variations are built. Medicare for all is a less threatening name for Universal Healthcare. Medicare itself is underfunded and under threat of failure every year. Every year congress cuts benefits and adds new rules and regulations.

      I don’t know about you, but I know I don’t want the government deciding what care and treatment I receive. If they eliminate the private sector then your only choice ill be the one the government offers.

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