Imagine an America in which a quarter of the monthly paycheck doesn't go for health insurance, and where no catastrophic illness burns through private coverage, bankrupting people just trying to play by the rules. In that America, people see their own doctors, and no hospital's main reason for being is as a profit mill. Children's parents never see a bill, and no one ever sees a morass of paperwork. Everyone, young and old, sick and healthy, shares the health care burden, and because of it, the burden is made lighter. Imagine an America with that kind of security, and think about the America we have now.
Do you feel the defect?
Make the jump with me below the fold for some ideas on how to fix it.
A Health-Secure America has:
- Birth to death affordable, single-payer health insurance for everyone, without restrictions
- Free health insurance for those under 19 years
- A health care plan paid for and governed by the participants themselves
These mandates are the essence of a national single-payer Health Security America plan that I have authored. All of us want some form of one and two; they are the sine qua non of universal health care. The funding and management of universal health care is trickier, and I expect all kinds of hassle on the third mandate. But as a doctor and administrator, I have been there and back. I have seen what once worked well to deliver the best, most efficient health care.
Shame of the developed world
I've been a lurker here at Daily Kos for some time, but this is my first attempt at a diary, and it is first in a series. Diaries on this blog have for a long time described our acute health care crisis succinctly and often movingly, but some critical elements are missing from most Democratic plans, and there are additional steps we need to take. First, at the risk of repetition, let me recap some of the miserable statistics that are the shame of the developed world:
- 45 million people have no insurance, 10 million of whom are kids--simply immoral.
- Premiums increasing double digits year after year , and for some employers, 34.1 percent increases in one year.
- Two different people with the same injury can legally be charged fees differing by 500%.
- Hospitals only blocks apart charge fees differing by as much as 112% for the same procedure.
- Prime-time ads and glossy mailings promote hotel-like hospitals and "today's purple pill," all eating up health care dollars, and still 10 million kids can't afford treatment in those hospitals or with those drugs.
- Our citizens think health care is the number one concern for this country, after Iraq.
That seems a reasonable concern to me. Does it to you?
Republicans are offering us health savings accounts and tort reform, which is about like giving opera tickets to starving families. And didn't we all just fall through their "doughnut hole"? They can not be trusted to offer a sound plan, and yet the Democrats are riding the same corporate/special interest gravy train. On the face of it, the House Democrats' plan looks noble enough, but in truth it has very little of substance that would work well, as currently formulated (I'll talk more about their so-called plan in a future diary). It is long past time for the Democrats to wipe the gravy off their faces and deliver some real health care reform. They need a structurally sound plan that will not drive the U.S. further into debt. I have been doing a great deal of experimenting and thinking along those lines, and I believe that I have just such a workable plan. But the entrenched insurance, pharmaceutical, hospital, manufacturer and professional interests will try to fight it, and that is why I am coming to you. Let's talk about health care, and what is needed.
In the eye of the vortex
Before going any further you need to know who it is who is audacious enough to offer a solution to America's health crisis. I am a physician finishing my 40-year practice life that started in 1965, the inaugural year for Medicare. I maintained a practice in the same small town of 2,000 in northwest Wisconsin during this time, but under different modes of administration, which was very instructive.
I began as a single family practitioner and thirteen years later, after adding partners, was president of a clinic corporation of nine physicians with three buildings in three communities. In 1978, our successful clinic merged with a much larger clinic in a town 45 miles away. After that merger, I got in on forming an HMO, sat on the board of directors of a much larger clinic and was the treasurer for six of my eight years on that board. When it comes to what went wrong with American medicine, you could say that I was in the eye of the vortex.
The mistakes we made were tantamount to making war on our local health care distribution system. And I do accept as much blame as anyone. At the time, we thought we were improving the system, not making it worse. Our clinic was approximately 60-80 doctors at the time--all great people and practitioners--but by 1988, it was obvious that things were a complete mess, thanks to the explosion of administrative positions, and a tangle of misguided red tape. I was having no success in correcting them or convincing others to do so, and so resigned from the clinic board.
Nothing really got better, and by 1992 we had merged with the world-renowned Mayo Clinic of Rochester, Minnesota. The health care distribution system still continued to worsen and I retired in 1998. A couple of years later I opened a one-physician practice making house calls, starting a simplified new method of practice with the latest, easily accessible administrative technology. To sum it up, I have been there and back. I speak from experience and years of living with the consequences of the decisions that my partners and I made to wade into the managed care swamp.
This is certainly a brief and unsubstantiated rendition of my career, so for the details of the, mistakes, the actions we took and the battles we waged trying to correct these concerns, I refer you to my website about the health care reform plan and the book I wrote about it. In Chapter 4 and the ensuing chapters, I tackle managed care with a scalpel.
I know the administrative models that function much better than the ones we tend to use now. These aren't pipe dreams, but ideas I have seen work, and which can work again to save our health care system without bankrupting the nation and its people. I will point them out as we go.
As I add further diaries explaining how this plan will work, please prepare yourself for discussing a roadmap to the three mandates, fixing mistakes we live with in our current health care distribution plan, assuming individual responsibility and more physician and other provider responsibilities, and a change in the paradigm of governing how our hospitals operate. We will explore which approaches we have to take to convince Congress to authorize the formation of the Health Security America plan, and cooperate even though we don't want taxpayers' money for everyone--just those in poverty. You will have to follow along for awhile but for those interested in getting ahead, I refer you again to the Health Security America website and the book "Health Security America: Fixing the health care crisis." Please don't misinterpret my motive. The book was written as a source book for the Health Security America plan. All profits from this book go to reform our health system. There will be no personal gain for me. The book, available at the website, through Amazon, and through any bookstore able to do a title, author or ISBN search, will make it easier for you to follow along and gain ongoing insight, including background, although I will do my best with these diaries.
The next diary explains why the third mandate of self-funding is necessary, and possibly the only way around the roadblocks thrown up on the way to a national single-payer system, and explains why the Democrats'current plan would deal a death blow to our few existing social safety nets.
And meanwhile Americans everywhere are suffering and dying. How do you suppose we get our members of Congress to do their duty for the greater good? As FDR once told a constituent who asked why he did not enact a certain bill, he said, "First you must make me." We the people have to make them do what is right.
FRED BANNISTER, M.D.