This year, I’ve been pretty good at remembering to write “2019” on the bazillion forms I do daily. What I didn’t realize was that next year is 2020.
A presidential election year.
As a broke medical student, I participated in a study that paid me $150 for a bone marrow biopsy. It was bad, but unlike an election, it was over quickly.
An election means we will be subjected to a barrage of ill-informed rhetoric regarding health care. At least ill-informed is bipartisan.
Several declared presidential candidates are espousing “Medicare for all.” A single-payer, government-run, ditch-the-private-system program will be the centerpiece of the election.
I can advise you on this topic as I am not running. Once, in third grade, I told my little brother to “quit acting like a girl.” Although I now deeply regret that gender-stereotyping insensitive comment, the only reason that I haven’t been forced to resign from doing infected pressure sores and drunks with jaw fractures is that no one else will do them.
“Medicare for all” means everyone gets a card enrolling them in a national health service. Private health plans go away, and so, presumably, do the premiums. Providers and hospitals are paid by the government. Taxes will have to increase substantially. The type and number of procedures will be regulated to fit a budget. Drug and hospital costs will be regulated as well.
Presumably the maze of different insurances, different costs for the same treatments, and the blizzard of confusing mail you get after a treatment will go away.
The arguments against “Medicare for all” are straightforward. We Americans like lots of procedures, the latest drugs, the fanciest hospitals and we want it now.
We don’t want waiting lists, and we don’t want gubmint telling us what hip we get and when. Did I mention taxes?
The biggest problem in dealing with health care is our own hypocrisy.
“$1500 a month for health insurance is outrageous!” Yet Ma had a hysterectomy, Pa had a disc done and Cindy Lou tore her ACL playing soccer. That’s an easy 100 grand. We all slurp at the trough with one side of our mouth and scream fiscal murder with the other side.
Go to a place like Scottsdale, Arizona, and you see hundreds of acres of multi-million-dollar homes with an Escalade parked in front. All on Medicare.
The salvation of our health care system now is the soaking of privately insured patients to make up for the massive shortfall created by Medicare and Medicaid patients.
So here is the solution. Government should be run by surgeons. Since we operate during the day, we don’t have time for meetings. Congress and the Supreme Court wouldn’t be necessary. We are almost there with universal care: Medicaid, Medicare, the VA and the Affordable Care Act. A very basic, life-saving, preventative health maintenance plan “for all” might be cost effective.
However, to satisfy the red-meat American Way, there would have be a second tier. Elective stuff such as hips, most heart surgery, cataracts, fancy drugs, futile end-of-life care — all that goes back on the consumer. Patients can pay cash or get secondary insurance plans. Doctors can offer competitive packages.
I do that already. Patients must really decide if they want a breast augmentation or a face lift. I must price those procedures so the patient can do it.
Direct consequences for our behavior might mean we become way less fat and way less careless.
So there it is. Problem solved. Now I have to burn my high school yearbook.