Healthcare for all?
|
table of contents |
By Guy R Rosenschein, MD
For about a month I have been watching
Arkansas Mensans talking about Health Insurance on the websiteI have not posted a word to avoid interfering with your feelings or your knowledge, real or assumed. Because of my background, probably unique in the state, I am in a position to comment and provide information about the topic. For twelve years I was a pediatric surgeon in Paris (France! Not Paris, AR) and now I have been a pediatric surgeon in the United Stated for ten years, mostly in New York and of late in Springdale, AR When people ask whether "I prefer being here or there", the answer is obvious, why would I be here, if I liked it better there.
Before proceeding I must correct a statement on the website, the number of people who died in France because of the unusual heat last July was over 10,000, probably close to 13,000. It was a very complex issue where socialized medicine was not the only reason.
I have heard, there and here, that medical care should be free for all. That may be part of the pursuit of happiness described in our Constitution. My problem with this idea is the priority it is given; obviously delay or lack of care may result in serious problems, including death, but we all know that lack of food results in certain death after a while and nobody seems to advocate free food for all. Until the grocery store stops selling food, and starts giving it away free, I will keep charging for my care.
Now that we all agree that doctors should be paid, the next question is who will pay. Surprisingly the answer is always the same, people with money pay for all, here in Arkansas, as well as anywhere else. Many of my patients are Medicaid patients, who pays the bill? All the taxpayers! Is it any different from socialized medicine, not at all. The reimbursements are so low that a business cannot survive with Medicaid only, which brings the next point, I could not take care of these patients without other payers who keep my business afloat, meaning people with insurance are providing medical coverage for Medicaid patients. For many reasons people will disagree with me but we have a form of socialized medicine.
Reading from the website I understand that a large number of people have no insurance, and I assume they do not qualify for Medicare or Medicaid. If they do not qualify, they must have some income. They choose not to have medical coverage because it is too expensive. This is where the French model will help, you must pay for the insurance, whether you like it or not. The government takes 10 to 15 % from your payroll, before tax, to cover Health Care, Retirement, and unemployment. If this is what you want to do, just do it now, give 10% of your income to an insurance, or HMO or PPO and you have "free" Health Care. Many people could buy insurance for this price, who is willing to? I do not know. Unfortunately, "free" health care, like anything free, is expensive.
continued below.
There have been violent conflicts in the competition
for water rights. It has become appropriate that the word "rivalry"
comes from the Latin rivus, a "stream."
The next point on this same topic, why is Health Care so expensive in our country? I will try to answer but I am not a lawyer. Remember that the price of malpractice coverage is only the tip of the legal iceberg. Thousands of people are employed in the hospitals and offices to review the charts and make sure they do not open the hospital or the facility to a possible lawsuit. All these people must be paid off your medical bills.
Patients expect the best possible care, and they have a right to get it. Mistakes happen and it is legitimate that people who suffer be compensated. The problem is what is fair compensation. If because of a mistake a patient will never have children, how much money should he/she get? If a patient will never walk again, how much is it? If a patient dies, how much?
Other indirect legal costs are the multiple tests given every day to patients who do not need them, but their lawyers may need them. We are talking billions in CatScan and MRI only. The state of Arkansas has limited the noneconomic damage patients may get, hoping to reduce the cost of Health Care, and I believe it will work after a while. This is a fair law that serves the public at large since many more people need medical care than compensation. For your information about the French ideal model, access to a MRI is difficult, but it is equal far (almost) all. Same for Canada where a family member had to wait three weeks for a CatScan after a chest mass had been seen on her chest X-ray. It is better than no insurance but much worse that what you get here with insurance or Medicare 1 Medicaid. At one point about fifteen years ago the French budget for Health Care, Retirement and Unemployment was equal to the state budget (it was not pant of the state budget at that time). Free care is very expensive.
You will ask me what is the answer. 1 have one: Health Insurance made mandatory for anyone with some level of income and provided by tax money far the others. The only requirement would be for the insurance to provide full hospital coverage, with a deductible no more than 10% of the yearly income. How you get insurance, where you buy it and how much you pay is left to the free market. This suggestion has one great quality, there is no new government body to create and pay for, including their health coverage! In France, the body in charge of the social services is huge, numbering hundreds of thousands well paid, and often useless, employees. They waste a large amount of tax money paid by all workers.
To reduce the expenses the French government has kept a very tight control on the providers' income, keeping away and abroad many talents.
They have not fired a single employee from the huge and wasteful government agency supervising the social services. An interesting anecdote happened about 15 years ago when the Board of Directors of that entity met in a restaurant in Paris to find a way to reduce the waste and ordered with their lunch a bottle of wine for several hundreds of dollars! This is what socialized medicine will bring us, is it called progress?
I gave you a very superficial overview of what National Health Care might bring us, and if you are not convinced, think how good the INS.
Your comments are welcome through the website, I will do my best to answer.