Thursday, July 23, 2009

Health Care: Building a Mastadon Out of Spare Crocodile Parts, When What We Need is a Pony

Let me start by saying: I don't know anything about health care or health insurance, except as a consumer.

Let me also say: I think Ann Coulter is an evil clown.

However, this recent column of hers raises some good points, I think, once you clear away her usual anti-liberal hysteria.

We all know this health care plan is not the one we would create ex nihilo. We all know we have to work with the muck we're mired in. We're not going to start from scratch. That's just reality. Insurance companies are going to be a part of any new system; they just are. Identical coverage for all citizens is never going to happen; half of the country is just set against it.

But why THIS? Can't we be any more imaginative with the pieces we have on the table? Why are our legislators showing SO little imagination?

Never mind; I withdraw the question.

Here's my Brilliant Plan. I challenge our gummint to tell me why something kinda sorta like this wouldn't a) work, b) be cheap and reasonable, and c) satisfy critics on both sides of the aisle.

DAY-TO-DAY CARE. Most of the time, most of us need to see a doctor for very minor maladies. Really, what we need is a nurse. We need an antibiotic. We need to see if something is sprained or broken. We need a throat culture. There is no reason why those of us with insurance should have to schedule an appointment with an actual doctor for this, at top dollar (regardless of who is paying), and those of us without insurance should have to clog up emergency rooms. Drug stores like Walgreens have started opening walk-in clinics staffed by registered nurses to handle just this kind of low-care traffic, and they're convenient, quick, and cheap. Why not encourage the entreprenurial spirit and let a thousand such flowers bloom, competing with each other for low cost and good (but low-level) care? I don't need health insurance to cover a quickie visit to a nurse when I need a flu shot. Let most of us handle this ourselves. And provide people below the poverty line--or some other line--with a voucher or a card that gives them either unlimited access to such facilities or a certain number of free visits per month.

CATASTROPHIC CARE. If we want to provide some level of government-supplied, universal coverage, without making conservatives feel like we're being nanny-statish, why not aim up here, where people can really suffer? Provide a high-deductible, catastrophic insurance policy free of charge (i.e., paid for by our taxes) to all citizens, so that if something horrible happens, it doesn't wipe out people and their families. With a pool as large as Everyone, it ought to be a reasonably cheap policy to create, maintain, and fund.

IN-BETWEEN IS UP FOR GRABS. In between quickie nurse visits and cancer surgery is a wide territory, and this is where the rich can buy their boutique insurance policies, those of us with families or chronic conditions or whatever can hope for good policies from our employers (which can still be a selling point in job recruitment), those of us who are young and healthy can go without if we so choose (to Coulter's point), and the poor can get some kind of government assistance a la Medicaid. I would think that insurance companies would be able to craft some kind of in-between-y policies like this that are attractive to people who need them and reasonably inexpensive for employers, since the scope of services covered would be much narrower.

I welcome your thoughts, you 2.5 people who read this.


PCarino said...

I like it, especially the nurse idea

(In the ob/gyn world, as you may know, there are medical practices built around nurse-practitioners and midwives, and doctors are only called in for emergencies.)

If you want more feedback and opinionated ranting, I will link to this on my FB page--with your permission.

Sandy said...

"those of us with families or chronic conditions or whatever can hope for good policies from our employers"

That's the problem, right there, because that's what we've already *got*, and it sucks. Hope? Really? Do you have any idea how many people fall into this category? As a person with a congenital problem that makes it impossible for me to buy an individual health insurance plan at *any* price, I absolutely hate the fact that I am tied to a job to stay well. If I won the lottery tomorrow, or wanted to start my own business, I couldn't quit my job. The main reason I fear losing my job is the loss of health coverage. If I were to choose to change jobs, one of the first things I'd need to know is what their health care coverage is like.

Coulter's article has an idiotic line about "universal food coverage" does she think food stamps are, if not exactly that?

Agathon said...

Good point, Sandy. And keep in mind, I'm not saying single payer is wrong, myself. I just have no faith we're ever going to see it here, given our peculiar politics. So I was just trying to brainstorm how else we could be attacking this issue.

So the question is, if the bottom and top work--how do we get at the big middle in a way that isn't employer dependent--or in a way where it can still be offered as am employment perk, but with other ways to get that mid-level or chronic care that don't HAVE to come from the employer?

Any ideas?

Oh, and yes--Coulter is an idiot. 99.99% of the time.