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HEALTH CARE à la CARTE

For those under 65 and not poor enough to qualify for Medicaid, the Health Care system leaves much to be desired. It is expensive, too many (perhaps 40 million minus the "mandated”) have no Medical Insurance, and those able to meet the pauperizing costs receive undefined, thus indifferent Primary Care medical services that are supplemented by referrals to various Specialists.  The result: fragmented care and too many costly referrals. This web site and its links propose changes that would Consolidate and Expand Primary Care. The only way to rescue Primary Care is to divide the current system into two components; Maintain HMO insurance for High Tech and Specialty Medicine;   Place Primary Care Medicine on a platform of Semi-Private Centers under the auspices of government sponsored Primary Care Centers of America, already flourishing in America. The ingredients of this bicameral system have long existed, initiated by President Truman when he created the USPHS, and subsequently empowered by President Johnson in concert with Medicare and Medicaid to serve the medically indigent as well as those with limited access to health care. Shortly after taking office President Obama, through the American Recovery and Reinvestment Act provided $500 Billion (some say more than that) to the “Primary Care Centers of America”.   Thus for the President to find the seeds of a more satisfactory Health Care system he need look no further than the 8000 or more Primary Care Centers of America, free standing and entrepreneurial currently offering Primary Care throughout the country.  Except for a small number of private practices certified as Primary Health Care Centers the vast majority are community based not for profit semi-Private corporations funded initially by Government Grants from the Health Resources and Services Administration (HRSA) and managed by a Board of Directors drawn from their respective communities. These centers, staffed by specialists in Pediatrics, Primary Care,  Internal Medicine, Gynecology and Dentistry are available to provide integrated medical and dental services to the medically indigent as well as any other citizen, with fees (zero to infinity) adjusted according to the ability pay. (for a complete description of the program and centers visit http://bphc.hrsa.gov/about/

 It is absolutely astonishing that so few of us seem to know about them. However, were their numbers to be significantly increased these Medical Centers would deliver more integrated comprehensive and robust Primary Care than is currently provided..

 All in all America’s entire Health Care System is comprised of two sectors:  (Medicare, Medicaid, Veterans, U.S. Public Health Service) funded and managed by the  federal  government; and one private in which individuals can buy medical insurance from any of an array of Health Maintenance Organizations (HMOs). The public sector is well accepted but the private sector breeds discontent, due in part to high annual direct costs and selectivity. Unless they comply with the mandate to buy into the system 40-50 millions of Americans must go without any Medical Insurance.  One of the whims of Capitalism is that many who cannot afford insurance pay more for immediate medical care than those that can although many families that buy insurance become financially strapped by its high annual cost.

The first step in dealing with the problem would be to flesh out Primary Care and then separate it from private HMO coverage. The HMOs would continue to insure for High Tech, Consultative and Surgical services as they do now, but no longer will have to cover Primary Care medicine.  By expanding Primary Care Centers of America, Primary Care Medicine would henceforth be covered by Community based Primary Care Centers as described above.  Thus there will be two systems side by side, one semi-public the other private. Under the Public System all Americans, (whether or not insured) will be assured the availability of Primary Care Medicine, fees adjusted to the ability to pay, from zero on up.  Those who prefer may continue to insure for Primary Care privately via the HMO route or direct payment. HMOs in the main would continue to carry High Tech, Consultative and Surgical practice, covering in-office as well as in-hospital care.

By removing transferring Primary care to pay-as-you go, Health Care insurance rates for families should be lowered significantly and fees for Primary Care Service would earn money for government.

At the very least, the immediate benefits of this change would:

Assure  Primary Care coverage for all Americans whether or not they carry Health Care Insurance

 Relieve Emergency Rooms of the burden of visits to by the uninsured, or Medicaid patients turned down by physicians in private practice.

Lower Health Care Insurance Costs for individuals, families, small and large enterprise businesses.

Robbed of many prior functions Primary Care under the HMO system has withered. According to some much of it can be conducted by telephone and thus is losing ground as a choice among young doctors. The days when the “family doctor” set broken bones, delivered babies and operated are over and properly so. But unfortunately the days when the Primary Care would normally manage a swollen knee and draw the fluid if needed, or inject a bursa, remove a cyst, or check a urine through a microscope are also over. Ask your friends whether or not their “primary care” doctor ever removed wax from their ears, drew a pap smear for the lab, checked a drop of urine through a microscope, excised a cyst or did a rectal exam to check for prostatic or rectal cancer. A current oft repeated criticism of primary care physicians is “all s/he does is refer me and write prescriptions”.    

 Primary Care physicians do not venture far a field because they have been handcuffed and “mind-cuffed” by the threat of litigation, subsequent retribution by the HMO and the fear one day of being grilled by a lawyer: “Doctor-- when did you become a Specialist in orthopedics (or urology, or dermatology)”.   However as a Federal employee the doctor would practice under the Federal Tort Claims Act (FTCA) that decrees: A patient who alleges acts of medical malpractice---cannot sue the--- the provider directly, but must file the claim against the United States”,  whereby the Attorney General becomes Counsel for the Defense, a daunting hurdle. 

The building blocks of my proposal are in place, but the must be multiplied many-fold, and made available day and night.  

It would be costly to establish but at a time when dollar bills are being scattered by the trillions the timing seems propitious and politically do-able. It can't happen overnight but carefully planned it could be in place within 5-10 years. NO NEW LEGISLATION would be needed. With each Center employing about 20-30 personnel (increased proportionately if open nights and weekends) and were the number of these CENTERS to be tripled to about 25,000 an additional half million or more jobs would be created. But we might well need 100,000 of these Centers. Large sums would be saved through efficient use of resources, integration of care, decongestion of ERs, and reduced number of referrals. Because the Centers are independent entrepreneurs and charge variable fees for service, fear of the “S”: words (aka Socialize and Single Payer) could be set aside. With Primary Care assured the costs of complementary insurance for families and business enterprise would be sharply reduced because in the main, younger people require little more than efficient General Family Care.    

Now that the Pilot Program of a National Primary Care Medical System is in place and functioning in 8000 or more of its Primary Care Centers  it is up to the President and his Administration to turn it into a Flourishing Primary Care Health Care Network that serves the entire country.

 

  DEAR MR. PRESIDENT —

THE PIECES ARE IN PLACE, 8000 OF THEM, EACH STAFFED BY PRIMARY CARE DOCTORS, INTERNISTS, PEDIATRICIANS, GYNECOLOGISTS AND DENTISTS (DERMATOLOGISTS OUGHT BE ADDED). *  

THESE CENTERS ARE tax free “hybrid” organizations guided by directors drawn from the neighborhood. FUNDED with GRANTS from federal, state, municipal governments, contributions from enterprise and money from the variable fees charged for services. THEY OFFER a greater variety of COMPREHENSIVE general CARE THAN MOST “PRIMARY CARE” OFFICES.  

FEE FOR SERVICE, ENTREPRENEURIAL AND CHARITABLE----that’s a run for the roses--what a combination! 

MULTIPLY the number of these centers MANY FOLD (100,000 in all)** AND YOU WILL CREATE EMPLOYMENT; ASSURE AVAILABILITY  of robust PRIMARY CARE; DECONGEST EMERGENCY ROOMS; liberate DOCTORS FROM the ever present threat of litigation; CURB THE EXCESSES OF HMOS; AVOID CONFLICT WITH CONGRESS ABOUT FUNDING.  

The greater the scope of general medical care offered by these centers the lower the cost of office care. 

EASING PRIMARY CARE FROM THE GRIP OF HMOs STRENGTHENS THE HAND OF GOVERNMENT --- AND THAT HAND MR. PRESIDENT, IS A ROYAL FLUSH—IN SPADES. 

 *  Staffed by well trained Generalists there would be no reason to include certified specialists on staff. 

 

 

 

 

 

 

CHARLES HARRIS MD

http://www.the-public-option.com                          Contact:busy-ness@comcast.net
Affordable Primary Care                                           

 

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