I am a strong proponent of a public option. My preference, for feasibility and affordability, would be a “Medicare for All” by choice, with a few caveats: ERISA needs reforming, Medicare reimbursement rates need adjusting to be more reasonable, and less punitive towards states that use health care funds wisely, and users are going to have to get used to taking a bigger bite of the cost sharing pie. Preventive care needs to be free or dirt cheap. Everything else needs to have a bigger co-pay, particularly emergency care. Perhaps we could spur the creation of Urgent care facilities with EDs, sharing a common triage. I’ve been to a hospital that does this, and the cost savings all the way around are dramatic. It keeps the sprained ankles, stomach flu, and URI’s out of the ED.
I am flummoxed by the dualing, yet completely incompatible arguments that Medicare for All as an option would eliminate the private insurance industry, or be a back door to single payer as the only option, and that a public option could not possibly be done well, since the government does nothing right (last I checked, Medicare recipients were thrilled with Medicare, except Part D).
Which is it? Is the public option likely to be another mishandled political boondoggle, providing nothing but terrible, substandard healthcare? Or is it going to be so wonderful that it single-handedly tanks the insurance industry, and launches the US of A on a trajectory toward communism?
Both can not be true.
What I am absolutely clear on, is co-ops are nothing but another method to take money from hard-working Americans, and give as little back in return as possible.
Just for giggles, google “Group Health wholy-owned subsidiary Kaiser Permanente”. Read. Keep reading. Read more.
We were members of Group Health briefly. Two months prior I had an emergency appendectomy. I had a two year old. We moved cross country. In the process of the move, I developed this nagging abdominal pain, not nearly as severe as the pain of the appy, but similar, and enough that it would make me break out in a cold sweat, and lasted hours, sometimes days.
After this happened several times, we went to see our new doctor at Group Health. In addition to the horrible pain, my whole family had a respiratory illness, and I was having asthma symptoms.
We were all seen at the same time. The doctor handled my issues first. He couldn’t hear any wheezing (I’ve never in my life wheezed, at least not until I’ve had a couple of rounds of albuterol and am moving enough air to wheeze), said antibiotics don’t cure viruses (without testing to see if we ultimately had one, but I’ll get to that later), and asked me about the abdominal pain.
I explained it started a couple of weeks after my appendectomy. He said I was acting like a hypnochondriac and I should stop whining. I had to grab my husband’s sleeve as he jumped to his feet.
A day later I was in the ED in severe respiratory distress with a particularly nasty and widespread bacterial pneumonia.
It wasn’t until more than a year later that I learned the reason for the recurrent abdominal pain. I had an abdominal hernia the size of a dinner plate. An incisional hernia. From my appendectomy.
Not only was it the size of a dinner plate, it was large, ragged, with little bits still clinging together, where intestines were getting stuck. It went un-repaired for some years, due to another move and back to back pregnancies. It ultimately was repaired during my hysterectomy, and the surgeon was none-too pleased with the complexity of the repair necessitated by the needless delay in treatment.
This was the first of a slew of negative interactions with Group Health. We had the option to change to Virginia Mason under the same plan, and we did, within a few short months. I can’t say the primary care doctor I saw at Virginia Mason was much better. In fact, she was awful, but the specialists we saw were incredible. I can’t place all the blame for the missed hernia at Group Health’s feet, my doctor at Virginia Mason missed it too (another post for another day). So did two Seattle area hospitals. In fact, the doctor who did catch it did so quite by accident, when I went to the ED with not only the abdominal pain, but also a 104 degree fever. He ordered a CT, and found the hernia. In spite of my reporting the pain began shortly after the appendectomy, not one doctor either looked at, or palpated my abdomen. Not one. Save the surgeon I was referred to after the fact to repair the defect (weeks before we were scheduled to move, damnit). He felt around, had me lie back and lift my head, and sure enough, there’s a ginormous hernia! Lookie there! More than a year of absolutely horrendous pain and suffering, needlessly. Actually, more than that, since it took me 6 years to get it repaired.
Some might point out that others missed the hernia too. Absolutely correct. However Group Health has the unique distinction of actually telling me to my face I was either lying, or a walking psychological pathology. They also had the only 0% accuracy rating I’ve ever experienced. Even Kaiser is right as often as a stopped clock.
It takes a concerted effort to be so bad you make Kaiser look good.
While fee for service as it stands now has no checks and balances, neither does capitation. Personally, I’d rather err on the side of doing too much (within reason) than doing too little (within reason). Both outcomes are known only in hindsight, but if I have to choose one, I choose the one that saves the lives that can be saved. Incentivizing the other guarantees outcomes we’d rather not increase.
