SINGLE PAYER AND HMOs
SIDE BY SIDE
 

Summary

 

 This innovative system (without disturbing the HMO Care programs) will:
                             1. Assure availability of Primary Care Medicine for all citizens
                             2. Decongest ER and add those patients to the single payer primary care system
                             3 .Provide primary care nights and week ends for all 
                             4. Lower Health Care costs for:
                                       a. Families
                                      b.
Enterprise
                             5. Provide medical nodes nation-wide to support service for Terror inflicted wounded.
                             6. Boost employment significantly
                             7. Put Primary Care facilities into empty Mall space
                             8. Curb the HMO penchant to raise rates
                             9. etc. etc. etc.

 

Except for the 37 million who have no Health insurance most Americans have medical and hospital coverage of one sort or another, much of it Single Payer: Medicare for the elderly, has been extended to include Addiction, Dialysis, HIV-AIDS and other special cases. Medicaid pays the medical bills of welfare recipients; Veterans are served by the U.S. Department of Veterans Affairs; Native Americans by the Indian Health Service;  and the remainder (except for 37 million) is insured privately by one or another of the numerous Health Maintenance Organizations (HMOs) that flourish throughout the land. Some join HMOs as individuals or as families, others get this coverage as an ERISSA byproduct of the insurance purchased by the industry, enterprise and other businesses for which they work. The gap between the insured and uninsured has been a noticeable stain on the social fabric of the United States that has been spreading slowly ever since Chancellor Bismarck introduced universal health insurance to Germany about 125 years ago. 

 

Some states have tried to remove the stain by allowing uninsured to buy into Medicaid, and during April 2006 Massachusetts passed law that mandated coverage, (awkwardly funded) for everyone in the state. 

 

Thus it was comforting after these many years to hear President George Bush in his 2007 State of the Union message invite this political wall flower to the dance by suggesting somehow health insurance of one sort or another ought to be extended to cover all American. But that’s where the music stopped.  For a brief moment New York’s ex Governor Spitzer had Health Care in his sights, but soon he himself dropped out of sight. Nonetheless, Health Care Insurance may be the buzz word of 2009. 

 

Because the problem is complex, because opponents are moneyed and plentiful, it is unlikely that a coherent national plan will soon be offered, but there is a short cut to salvation that would provide an adequate stop-gap until a comprehensive Health Care System is developed.  Namely to move Primary Care from the HMOs into a Single Payer System staffed by salaried physicians. In 2004 37% of all physician office visits were to offices of Primary Care physicians. This figure does not include visits by the uninsured to the Emergency Room, or visits during nights and weekends by Insured individuals who, unable to locate their physicians were forced to go to the Emergency Room.  

 

A Single Payer System limited to Primary Care could be set up side by side with the current HMO structure. Although not comprehensive, the entire nation would with the stroke of a pen have medical insurance for Primary Care. The Congress could fund this on a national level or foist it on the States as partially funded mandates, and derive subsidy from HMOs that no longer would have the Primary Care burden. It could be a great boost for doctors starting in practice and wonderful haven for doctors at retirement age who hate to leave the profession. It would unburden Emergency Rooms to which the uninsured flock often for paltry problems, and it would be a model with which the klutzy HMO system can be compared.  

 

HMOs would continue to insure for Consultation in medical specialties, surgery, radiology, high tech procedures and hospitalization.  

 

When necessary Doctors servicing The Single Payer System would refer patients to specialists in private practice best suited for specific ailments, whether or not they were attached or not attached to HMOs. Referrals would not be restricted to specific panels, an insidious proscription built into HMO contracts that deprives patients of choice and gets in the way of good medical care.  Medicare and Medicaid, titles 18 and 19 of the Social Security Act specifically guaranteed patients their choice of doctors, a freedom severely restricted by the HMO consortium. The Single Payer System would honor that commitment. 

 

 Primary Care single Payer isn’t a cure-all but a first step. For the most part, the uninsured are young and have a low incidence of serious medical problems. Special funding could be arranged to channel special cases into the HMO system. As the parallel systems matured the Single Payer component might be able to enlarge the scope of its operations.    

 

Two systems running side by side would give the much maligned single payer concept a chance to be compared by the public with the private insurance industry’s Health Maintenance Organizations and give the government a chance to measure the costs and efficiency of each.  In a competitive system competing parties continually strive to improve performance. Currently there is no incentive for this. 

 

The tension between single payer and other forms of coverage has long existed, and doctors always made the argument that “socialized medicine” their term for any effort by government to do good would restrict “free choice.” The doctors seemed to believe that they were the last bastion of free enterprise in this country. Flattered, funded and bolstered in this belief by industry and enterprise they fought “socialization” to the bitter end, only to discover that they had indeed been “socialized”, not by the fearsome government, but by their “friends and allies”,  in industry.   In the still of the night HMOs sprung up like sunflowers and enslaved the medical profession and patients as well.

 

 A Single Payer System side by side with HMOs, even if limited to Primary Care, would give the public a chance to make choices and vote for them.

 

GUESS WHAT?

 

When I first envisioned this system described above I had no idea that it actually EXISTS in the form of Primary Care Centers created by Grants from the HRSA (Health Resources and Services Administration under HHS The Department of Health and Human Resources). There are 8000 of these Primary Care Centers scattered all over the country. For a more complete description visit:

 

 www.the-public-option.com 

 

I have placed Hard Copy of this information on the desks of every Senator (100) in the United States only to find that 99 of 100 individuals in charge of Health Care were unable to meet with me.

 

It is ludicrous that Senators and Representatives should argue back and forth about support or no support for a system that has been in place for 50 years. The Congress actually funds them. HOW CAN THE CONGRESS VOTE FOR OR AGAINST A SYSTEM THAT IS IN PLACE AND FUNCTIONING??? Wake up boys and girls, the future is behind you.

 

It seems that the current “cure” is to force all Americans, namely the young who feel they do not need Medical Insurance to buy it in order to bolster coffers of a failing system. That is obscene. Expansion of Primary Care Centers will, on he other hand, lower costs.

 

www.primary-care-medicine.net                                                                                      Back