[Paleopsych] government/business in health care

[Steve Hovland]

I agree that first-dollar coverage is part of the problem.

I think some combination of HSA's and major medical
is practical.

But there also needs to be some kind of system to
make sure everyone gets a modicum of care.  

I definitely do not think any insurance program should
be paying for heart transplants.

I seem to recall that in the State of the Union message 
the President talked about putting some kind of clinic in 
every town and neighborhood.  If they fund it that is the 
right kind of idea.

Years ago I dated a woman who often vacationed in
Mexico.  One time she suffered an injury requiring
stitches.  She went to the little government clinic in the 
nearby village and was treated at no charge.

No matter who the payer is, they need to have sound
business processes in place.

Steve Hovland
www.stevehovland.net


-----Original Message-----
From:	Lynn D. Johnson, Ph.D. [SMTP:ljohnson at solution-consulting.com]
Sent:	Tuesday, February 15, 2005 8:00 PM
To:	The new improved paleopsych list
Subject:	Re: [Paleopsych] government/business in health care

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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