[Paleopsych] government/business in health care

[Lynn D. Johnson, Ph.D.]

Michael's question is good - what alternatives can one recommend?

I have worked in mental health for 30 years and done most of my own 
billing and insurance work. I find government programs are always the 
worst to deal with, and the additional problem, Michael, is that they 
are a monopoly. Both Medicade and Medicare have this impossible quality, 
and I think that quality suffers when government meddles. I resigned 
from a local panel with about 40% of the local population because they 
were difficult to deal with. I cannot do that with Medicare. If I want 
to make my living by only working on panels that treat providers and 
clients with respect I can do that. Hence my fear of government monopoly.

I recommend . . . (drum roll, please) Health savings accounts for all 
people.  This means personal ownership. It is your money, and you can 
shopt around. A friend of mine did just that. She and her husband had 
high deductable insurance, and when he needed an appendectomy, she 
called a half dozen providers and chose the cheapest one. Guts! But it 
worked out well. The cheap provider was an older surgeon with less 
overhead and less need for materialistic phallic symbols. He did a good 
job on my friend.

With the no-deductable plans today, there is no incentive to do that. 
HMOs and prepaid plans can be very good (Kaiser seems to be excellent) 
but if I had only one answer, I would say HSAs.

Complete medical coverage has been a  perverse incentive. It raises 
costs. Why should pharmaceutical companies compete when patients do NOT 
shop on the basis of cost? (Well, I always do, but most people don't).

Hope that helps advance the dialog, Michael.
Lynn

Michael Christopher wrote:

>>>I fear government enforcing this excellent idea,
>>>      
>>>
>since I work in health care, and government in health
>care is always a disaster.<<
>
>--What alternatives do you recommend? I'm not
>convinced that business in health care is any less
>bureaucratic than government. Business culture, at
>least when a few large corporations dominate the
>market, seems to have some of the same problems as
>government culture. The assumption that the market is
>the friendlier force is often detached from an actual
>comparison between people's experiences with
>government and with business... those who have the
>money to pay for good service (money does talk) are
>often isolated from what others experience lower down
>on the ladder, and they don't always realize the
>consequences of making drastic changes in the system
>because they are insulated from the effects of those
>changes, beyond reducing their own taxes. For many of
>the wealthy, as long as their own tax rate goes down,
>everything's great. They don't always mingle on a
>daily basis with people who don't have the same
>resource, and it produces a lag time in the feedback
>network that makes a society capable of reaching
>balance. Ideally, those who make changes in a system
>will be tapped into all levels of that system, and
>respond to realtime feedback. Ideally, those who vote
>for changes should have at least some contact with
>people most affected. That isn't always the case.
>
>My wife, who is from Australia, keeps complaining that
>the large companies here don't put real people on the
>phone for customer help and give people the runaround.
>She feels Australia does better. She can be a little
>patriotic about Australia, but then my mom says the
>same thing and she's lived here all her life.
>Corporations are not always less bureaucratic and
>alienating than government, and there can be just as
>much red tape, from what I've seen. 
>
>Michael
>
>
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