Friday, December 11, 2009

The medical payment system

One can rant about the health care Insurers, or one can try to examine attempt to devise some code to govern the health care system; Robert Reich attempts a little of both. One first has to understand this is not really about health care, but about payment for health care. Anywhere One goes in this country, almost Everyone gets a high quality of care; the real problem develops when One goes to pay the bill. I went to talk to my Doctor yesterday, I say talk because his nurse had already informed me of the relevant information, and he and I were both impatient to get on with our busy lives. This only tells Us that We had to touch base, simply so that he could be paid for valuable supervisory activity. We could have both skipped it, and been quite happy!

The fact stands that Americans are tested too much, medicated too much, and pay too much; all because of the system of payment. We are tested too much due to malpractice liability. We are medicated too much due to the fact that Americans cannot face a simple statement that they are Sick and should simply wait it out, and we pay too much because we insist on splitting the entire procedure into too many parts. It is a question of Divide and Multiply–not Divide and Conquer. It is obvious that many medical procedures can be compiled into a set unit Cost, that many of the most common Proscriptions could be switched to the Pharmacist providing relief to the Doctors, and that bi-yearly Check-ups could substitute for continual imposition on Doctors; saving their efforts for real medical problems. There is the way the medical system should run, and the way it stumbles along.

I would approach the problem of health care in a harsh manner. I would favor a health care measure where Government would pay for two medical visits per year in entirety, but leave all other medical costs to private Insurers; the Check-Ups standing in as defense from malpractice. This would cost about $60 billion per year, and would be fronted by a Triage system where Nurses must agree to arrangement of an Appointment, under the supervision of the governing physician. I would allow Pharmacists to proscribe a list of medications allowed by a formal national medical commission; also allowing for Pharmacists writing a Note to School and Workplace proscribing Time off. The law would set up the practice of a Standard rate for Lab services of all types defined by the medical commission, where there would be only one rate charged for all Patients. The law would also entail that Doctors be allowed only 6 examinations per day, on which they would be paid a set rate, but allowed any amount of subsidiary labor to handle distinct medical problems previously discerned or emergencies. I hope this would lead to a better allocation of time, and bring medical Costs within reasonable payment range. lgl

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