Vermont’s House passed legislation that is intended to lead to single-payer:
After a full day and evening of debate, the Vermont House gave preliminary approval to health care reform legislation that’s designed to put the state on the path toward a single payer system.
Here’s the original proposal:
Under Shumlin’s “single-payer” system, Vermont residents would receive health benefits paid for by the state, regardless of their employment status or income. The plan is designed to help stem rising health costs, which state officials say have become unsustainable.
“Health care costs are climbing at a rate of more than 12 times the growth of the Vermont economy, and we’re not getting the best value for our money,” Shumlin said in a prepared statement. “The time for change has come.”
It seems to me that Vermont is suited for single payer for several reasons, one of which is community health centers.
Here’s a brief description of community health centers:
Spread across 50 states and all U.S. territories, there are 1,250 Community Health Centers that provide vital primary care to 20 million Americans with limited financial resources. Directed by boards with majority consumer membership, health centers focus on meeting the basic health care needs of their individual communities. Health centers maintain an open-door policy, providing treatment regardless of an individual’s income or insurance coverage.
Vermont uses community health centers in a big way. They have a basic non-profit primary care delivery system in place, which I believe makes them a good candidate to put a public payment system in place.
Vermont has 625,741 people. In 2009, 107,691 Vermont residents received care through a community health center.(pdf)
Compare that with Ohio, where of 11,542,645 people, 475,000 were community health center patients in 2009.
The stimulus provided an extra 2 billion in funding for community health centers. The PPACA provides 11 billion (appropriated-there’s 34 billion authorized) in new funding over the next 5 years, and the estimate is that will mean 40 million people will be using a community health center by 2015.
As I have mentioned here before, I once relied on a community health center in Ohio for pregnancy care, on a sliding scale fee basis. It was a normal pregnancy, I was young and generally healthy, and the “team” approach to what I believe was called “wellness” was a good fit for me. It was a very positive experience during a difficult time. I saw a nurse, a social worker, a nutrition person and a physician. I went to the same crew for well baby care.
I now have health insurance and live in a rural community where I go to a private for-profit medical group. If I had a choice I would opt for the community health center model. I don’t have a choice. The for-profit medical group I use is the sole non-emergency provider for two counties, so I’d be traveling 40-some miles to go elsewhere. They have several locations in the two counties, but it’s all the same entity.
Here’s my question. If you have adequate health insurance would you be open to the idea of a non-profit community health center approach to primary care, personally? Would you go to a community health center for primary care, even if you have insurance coverage that covers for-profit, private health care delivery? Would you be open to changing not just the mechanism for payment, but your personal health care delivery, at the primary care level, voluntarily?
Understand this is not the Vermont plan, nor do I mean to imply exclusively non-profit delivery of primary care is the Vermont plan, or the eventual aim.
Socraticsilence
This is though why the “Bernie Sanders sold us out” crowd was so freaking dumb– hello, guy basically won funding for the enhancement of an already developed CHC infrastructure in his state which could help Vermonters move on to Single-Payer and will help them lower the cost of healthcare whilst simultaneously improving the quality of said care.
GregB
Vermont was the first state to implement civil unions. Back then it seemed so forward and now it is widely accepted by large numbers of people as something not even controversial.
Vermont is the point of the liberal spear.
Yutsano
Not to raise too fine a point on it, but Canada did not get universal health care all at once. It started in (of all places) Saskatchewan thanks to the efforts of their premier, Tommy Douglas. It then became a national crusade for him, but the start of it all was a Prairie province. Once Ontario was on board the rest of the dominoes fell into place. Thank you Vermont for having the courage to be first. I’m hoping this emboldens California to take that leap, because if they can manage to do it that will definitely cause a cascade effect.
Zifnab25
All things being equal, I’d choose the community health center every time. I don’t need a “doctor” to fill my every medical need. Just a professional.
That said, I’d still opt for quality first. If private care really was the better coverage – cause they had the most experienced doctor or the best facilities or what have you – they’d be my first pick. Likewise, if the CHC trumped quality or facility, they’d be my choice.
Starfish
Yes. I go to the Minute Clinic because it is fast, the pricing scheme is clear, and it is convenient. However, they are not allowed to treat animal bites. At that point, I caved and called my doctor who got me in the next day. Minute Clinic is less expensive than my doctor and can see me ASAP. My doctor is somewhat more expensive and could see me the next day. He could also give me free samples that Minute Clinic could not do.
So long as the community clinics are well run, and you are not sitting there like it is the DMV, people will go.
kay
@Yutsano:
There was never going to be a massive disruption in the US, either. The vast majority of college educated white people have health insurance, and access to health care. We were never going to disrupt them in some radical fashion.
Nicole
I’d also go to community health care centers for my and my family’s basic care. Like Starfish, my only concern would be that it’s not an all-day experience in terms of wait time. As it is now, I often wait at my doctor’s for an hour before she sees me, and I can live with that; I just wouldn’t want it to be like the ER is here in NYC where you should bring a novel to entertain yourself while you wait to be seen. A really long novel.
Yay, Vermont!
Cris
That’s pretty much why I was really trying to move there about ten years ago. My go to line was “I want to live where progressives are writing legislation instead of fighting it.”
That’s a pretty rose-colored view, of course. VT is as complex as any state, and there was enormous backlash against Dean over civil unions. But I’m still impressed by its prevailing political orientation.
Yutsano
It’s not the right question Kay. It’s the fact that you have adequate health insurance and too many people in this country do not. I have what is considered gold-plated health insurance so I can get very decent care at what turns out to be a very fair cost to me. I don’t understand why, just because of virtue of my employment, that I get this and someone who works at McDonald’s doesn’t get the same standard of care. Federal health benefits shouldn’t be the gold standard, they should be the MINIMUM that anyone gets. And there hasn’t been a better delivery system found than either tightly regulated private insurance or single payer.
@kay: I’m also a huge fan of the Australian model, which is a public/private split. If you can afford it, you get the private stuff, but there is ALWAYS a backstop to make sure you’re adequately cared for. I really still think that’s where we’ll eventually end up, and the best part is most of the mechanisms are already in place. We just need the political will.
New Yorker
Sure. I suppose I should add a disclaimer that I’m also in good health, have no chronic illnesses, take one prescription drug (and only rarely, when I have an allergic reaction to dogs or cats), and have only been to the ER once in my life. I’m fortunate enough to be that person who shows up at his PCP once a year just to make sure everything is fine as always, and I could do that at a community health center.
Anonymous At Work
I work for and am near a university with medical school, and several affiliated hospitals. I use a clinic for primary care associated with this medical complex, in part because I am a guineau pig for medical student, interns, residents and fellows whenever I visit. I would continue to use this clinic for that purpose if a Community Health Clinic was available.
For professional-but-not-doctor type care, I work with and know a good number of doctors and nurses that I can ask for a quick opinion anyway.
Tom Johnson
The question is too abstract. Whether I would choose a community health center is dependent on what the community health centers were like. If they were some kind bureaucratic, Soviet-style horror, no. But if they were clean and service-oriented, sure. We already do routine stuff through doc-in-a-box offices that dispense basic medications and aid rather than either going to the hospital or sitting for two hours in the doctor’s waiting room
dr. bloor
I would and I do. Eight docs plus support over two or three locations around the state, and the first question they ask when you call is “would you like to be seen today?” They have an in-house plan for uninsured and underinsured patients. Nothing in the office runs into three figures out-of-pocket. A little hectic at times, but good, sensible care.
kay
@Yutsano:
I don’t agree. I think we have a problem with the cost of health care.I think we should fool with the payment mechanism, but we’re also going to have to deal with quality and value.
Vermont does too. That’s the driver here. Cost.
Massachusetts is near to squeezing all the cost-saving they can out of the payment mechanism side. They’re moving to actual health care reform.
I think it eventually gets addressed. Vermont started with the “value” side, and now are going to payment. Massachusetts first fixed payment, and now go to value.
kay
@dr. bloor:
Thanks for the straight answer.
New Yorker
@Nicole:
Yes, I made the mistake of going to the ER for a severely swollen throat from mononucleosis. I didn’t realize that unless you’re having a stroke or heart attack, you don’t get treated as an “emergency”. Add in that this was Woodhull Hospital in Bushwick (the closest to my place) where I’d wager that 3/4 of the population doesn’t have health insurance and thus goes to Woodhull for primary care.
After 4 hours of “Judge Judy” and the like, I finally saw the doctors who cleaned my throat out, shot me full of anti-inflammatories, and sent me home with a codiene prescription, all in the space of about an hour.
Legalize
@New Yorker:
Ditto. Amazing how diet and exercise keep health care costs down.
Redshift
I would love to have a nonprofit option. I rarely need medical care, but Ms. Redshift has chronic health conditions, and while we have coverage and our doctors are fine, dealing with insurance whose every incentive is to find ways to avoid paying is a constant struggle.
kay
@Tom Johnson:
Well, one of the reasons I asked was that panicked “answer before the question” that kept coming up in the debate.
“You can keep your doctor!” Remember that?
I’m wondering how committed people are to the particular provider they’re accustomed to.
For me it’s “not at all”.
Cris
The exact same thing is true for me.
This is what makes us liberals: we recognize that we benefit from a somewhat arbitrary distribution, and we want to see even more people benefit the same way. If we were libertarians, our reaction to this inequality would be to blame those McDonald’s employees for not being as fortunate as us.
Yutsano
@kay: I think we might be talking past each other, cause I really am not disagreeing with you. I think we might just need to rephrase the question, to borrow a term from your professional venue. I have used community clinics before, they are a great alternative to the ER, they are efficient, and even with my private corporate insurance I paid only $20. I’m a huge fan of them.
jnfr
In a heartbeat. We have decent insurance, but I hate having to cobble together my own network of providers. We used to have Kaiser, which operates as a health center with all kinds of generalists and special1sts and services under one roof, and we really miss that.
jnfr
Oops, beware the special1st word, it triggers moderation!
kay
@Yutsano:
It’s a little bigger than that. The word “fragmented” comes up again and again in health care reform (as opposed to insurance reform).
They want you to have a “health care home” so you don’t get “fragmented” care that is both more costly and has a less desirable result.
We’re going to apply this to poor people,under PPACA (hopefully) and Vermont is going to apply it to everyone.
MikeJ
@Legalize:
It’s amazing how much diet and exercise cost too. Healthy food is more expensive than junk, and even if you don’t count the cost of a gym membership (and the professionals there who can help you do the right exercises for you without injuring yourself), the time involved in exercise is more of a problem for the poor than the well off.
Yes, both are important, but let’s not pretend healthcare is the US can be reduced to “lazy people eat cheeseburgers and fill up the waiting rooms.”
Yutsano
@kay: Ugh. I hate getting into interesting discussions then having to leave. Damn my kitteh overlord’s need to be constantly fed. :)
(Okay, I like having a place to live and cash for stuff to buy too. But still…)
kay
@Yutsano:
Oh, feel free. I’m going away for a week here shortly, so I should be preparing. I’m only going to Chicago and then Michigan, so it’s not this huge deal.
cleek
@Yutsano:
in my case, it’s pretty obvious why: my employer runs an on-site health care center for employees and their families. obviously that’s wildly atypical.
still, i bet they’d love to be out of the health care business. though i expect they’d keep a health center on-campus for simple employee convenience.
but! mah freedum!
Incoherent Dennis SGMM
Kay, I’m with you one hundred percent – as long as the care is provided only to those who have earned it. The second you start letting in the unemployed, people of the dusky persuasion, or those who have a bunch of kids they can’t afford, then it’s all just a damned, dirty soshulist plot.
/Teabagger
Mnemosyne
Right now, I do have a doctor in sole practice who I like, so at the moment I would not want to switch. I have had Kaiser in the past, though, and that can be a good model — as jnfr said, they have everything under one roof (or at least one system) so it’s easy for your doctor/nurse practitioner/physician’s assistant to refer you along to a specialist if necessary.
Davis X. Machina
I was a Harvard Community Health Services member back in the early ’80’s when its community roots weren’t just a rosy memory.
Been HMO’d PPO’d, and such since, and would go back in a heartbeat. But Harvard/Pilgrim Health Care isn’t even close to what it was as a youth.
The idea of a whole state like that, well… it makes my liberal knees all wobbly.
Redshift
@Legalize: Except when it doesn’t. I have been pretty much equally healthy when I’m in pretty good shape and eating pretty carefully, and when I’ve been thirty pounds heavier and following no diet beyond “eat real meals, not just chips and soda.” My wife has several chronic conditions, one of which is purely genetic and isn’t going to be helped more than minimally by diet or exercise (and to compound the problem, it makes it difficult for her to exercise.)
Diet and exercise are good to keep in mind, but those of us who take care of them and have good health should be wary of being too self-congratulatory about cause and effect.
Mnemosyne
@MikeJ:
I think that’s one reason it can be good to give employers incentives to improve their employees’ health (though it can also go horribly wrong depending on the company’s culture). If your employer is actually offering you incentives to get nutrition advice or organizes exercise classes, I think it gives employees permission to do those things.
Right now, the Giant Evil Corporation I work for offers actual money (either in your flexible spending account or as cash money after taxes) to hit certain health goals, like having a normal cholesterol level or a BMI under 26. That’s the kind of stuff that can actually work, rather than trying to scold or shame people into changing.
PurpleGirl
Point of fact: ER = Emergency Room. They triage patients as they come in, those needing faster care get faster care. If your problem is not life-threatening, you will wait to be seen. They cannot see everyone at once.
I was recently seen at a City hospital ER; it took time. The important thing for me though was that having gone there, the ER was able to confirm my problem and get me an appointment with the hospital’s diagnostic clinic for a fuller work-up. Now that clinic has a handed me over to a community center for continuing care. Actually, the diagnostic clinic staff gave me better care than the private group practice I’d gone to previously.
Cris
I don’t want to go into a 50-comment Pandagon-style food derail, but this isn’t exactly true. Junk is far more convenient, and our whole society is engineered to make it more convenient.
But a bowl of whole grain rice doesn’t cost more than a bowl of blue box mac & cheese, a bowl of oatmeal costs far less than a bowl of Cookie Crisp. And though you can order off the dollar menu at McD’s, I’m shocked at how easily I run up a $20 ticket at KFC.
Junk is pushed on us as our default option. I don’t blame anybody for thinking it’s cheaper and easier, but I just think it’s neither.
Proportion Wheel
I live near Burlington, Vermont. I was startled, Kay, to read that you only have one for-profit practice to serve two counties. Aside from Burlington’s Community Health Center, Chittenden County has a number of physician-run private practices, typically staffed by one to five physicians along with nurses, nurse practitioners, and physician’s assistants, as well as a larger practice run by the local hospital. I’m guessing that Vermont’s regulatory climate makes this possible, or somehow makes it harder for the big corporate providers to move in and take over. At age 64, it seems important to me to have one physician who is familiar with my medical issues, but I could live with a “team” approach if the system was well run. The practice I use (2 docs and support staff) can generally see me within a day or two, faster if the situation merits, and I seldom have to spend more than a few minutes in the waiting room. I don’t know all the ins and outs of why health care seems to work better here than most places, but I sure am glad to have access to it. One factor is clearly that small practices run by caring physicians work better than big, bureaucratic practices run by corporations. Seems like most of the country could learn from Vermont, even aside from the single-payer initiative, which I fully support.
kay
@Incoherent Dennis SGMM:
Hah! I (partly) modeled how I treat my clients on how I was treated at that center. The physician was a practical person. No judging. She was there for health care, not to deliver a lecture. She was also relentlessly, (almost) annoyingly cheerful.
Cris
Which is why the GOP talking point about how the ER is our nation’s de facto free health care was so odious. They were openly endorsing overwhelming the triage system and making people wait longer.
kay
@Proportion Wheel:
It’s rural Ohio. They have trouble recruiting physicians. I don’t (actually) blame doctors. The weather sucks, the public schools are under-funded and mediocre, there’s no shopping or entertainment of any kind, and the average income is 34k.
There’s enough physicians and locations. It’s just that they all work for the same entity, which is a little alarming.
Gina
I kind of do already, for my regular doctor. She’s part of the Albany Medical Center system. I do see specialists for allergy stuff, but was referred by said regular doctor. I like it a lot, the model has served all of my family very well since we’ve lived in the area. We have one of those Cadillac Plans ™ from my husband’s job as a gummint lawyer for the state that lets us choose where we want to go.
Brachiator
@kay:
It’s not just about whether it’s non-profit (whatever that means). It’s about the services that are rendered.
Also, and I’ve asked this question numerous times. I don’t know why Americans insist that single payer is the holy grail of health care, when it is not universally used by other countries that provide health care.
goblue72
I live in California and have Kaiser HMO through my employer – which is basically like getting healthcare from a nonprofit medical care factory – roll ’em in, roll ‘
em out, quick as you can.
I had a Blue Cross PPO plan with a prior employer which sounds awesome but was horrible in practice as it was next to impossible to find a decent GP taking new patients, let alone if I had an issue I needed a specialist for. And Blue Cross answer to helping me find a GP was to send me a list of doctors within a one mile radius of my zipcode. I live in San Francisco near downtown – there’s literally 100s upon 100s of doctors. I seriously considered using Yelp at one point – which is really pathetic if you think about it.
So, yes. I would whole-heartedly utitlize a CHC for my primary care.
goblue72
Ack. FYWP. My comment is in moderation. No idea why – I didn’t use any words that could be caught in the dreaded penile enhancement drug filter.
kay
@Brachiator:
It isn’t the holy grail, for me. I’m open. I think payment mechanisms are the less-important part of health care reform. I think you have to eventually get to the cost of health care, once you’re through screwing with who pays whom,using what mechanism.
Vermont wants single payer because it allows more control over cost and access of health care, and, as I said, they have a basic primary care system existing, that people like and use.
Jules
Kay, if I had the choice I would use a community health center and we do have health insurance.
gbbalto
@goblue72 (43) – How about “uT*Tlize” in yer last line?
Mnemosyne
@goblue72:
It’s so weird to me that Kaiser in Northern California and Kaiser in Southern California can be so different. Everyone I know who has Kaiser in NoCal has horror stories about them, but most people in SoCal are pretty satisfied.
When I started seeing scary headlines about systemic screwups at Kaiser with transplants, I knew it was Kaiser in NoCal, not SoCal. And it was. Is it a management thing, or what?
Legalize
@MikeJ:
I’ve never been particularly sympathetic to this argument. Healthy food is not de facto cheaper than unhealthy food. In fact, often times, it is far less expensive than unhealthy food. Compare, for example, the cost of feeding a family of 4 at Wendy’s to buying a couple of boxes of black bean burgers, some spinach, a couple of tomatoes, an onion, some Kroger brand wheat bread, and some mustard. It might be more convenient to eat crap, but its not necessarily cheaper.
Exercise isn’t particularly expensive either. My gym membership costs me $24 per month, bundled with the wife’s membership. You certainly don’t need a private trainer to get a decent workout at a gym. You also don’t need to workout at a gym in order to get good exercise. Walking briskly for 30 minutes outside a few times a week is excellent exercise.
Of course diet and exercise aren’t the end of the story, but there’s absolutely nothing but upside, in terms of cost and health.
gbbalto
@goblue72 – No, that can’t be it – appears in too many words…
Jay C
Well, we live in the middle of Manhattan – certainly no desert AFA medical providers are concerned; and I’d (and probably even the partially-disabled Mrs. Jay) use some sort of urban CHC as an alternative to an ER: as pointed out, ER efficiency seems to be a function of demand and population: and in NYC, you have excessive levels of both….
Brachiator
@kay:
Makes sense, and your explanation of the situation in Vermont gives a good sense of what the issues are there. Thanks.
Mnemosyne
@goblue72:
@gbbalto:
The word for a doctor who has a specialty practice has a boner pill’s name in it.
The Raven
@Legalize: “Amazing how diet and exercise keep health care costs down.”
I don’t think so, actually, once actual malnutrition is ruled out. There are reasons to pursue a healthy diet and exercise at any age, but these mostly make a health difference later in life, past 50 or so, when the diseases of old age start making themselves felt. And even then, there’s a paradoxical effect: diet and exercise can keep an older person healthier, so that they can then fall prey to other very serious and expensive diseases of old age. (Sorry, not going to go dig up the stats right now.)
As to the original question, I am very struck by how much good care I have gotten from university health care groups, which are similar to community health centers. A great deal depends on convenience, but I would use a CHC if I thought well of it.
gbbalto
@Mnemosyne – Argh, of course. On topic, I and my entire immediate family will vouch for the Canadian single payer system after decades of consistently excellent service. In U.S. now and have Fed BC/BS (very good for medical, not much good for dental) but would prefer the Canadian system.
RosiesDad
@kay:
I’m married to a family physician and am a veterinarian. I have a family physician who I see for physicals every couple of years but I’m not wedded to him or his practice. I have familial coronary artery disease and see my cardiologist a couple of times a year and I would not be inclined to turn my cardiology needs over to a committee or to other unknown docs. Lastly, I am likely going to need knee surgery in the not too distant future and there are a couple of local orthopedists I would trust to do the work but would not be inclined to allow this to be determined by committee or a surgeon I did not personally select.
RalfW
I am a member of Health Partners in Minnesota. It’s a tad confusing, even for me, since I’m both a Health Partners Insurance customer and a Health Partners Clinics patient.
But if I understand it correctly, they are both non-profit. I know the insurance co is, by Minnesota law. It bills itself as the “largest consumer governed non-profit health care organization in the nation.”
I believe that is across the insurance (1.3 million plan members) and the clinics (400,000 patients – but not all one are the other, the Clinics accept multiple payers).
I’ve had excellent care and service, particularly since they moved away from the HMO model about a decade ago. Time was when you’d have to explain your embarrassing minor condition to some faceless paper pusher, who would try and get you in to a clinic in 2-4 weeks, unless you were dying.
Customers, obviously, hated that. And I gather it didn’t save money, it just wasted time. So now they strive for same-day/next day appts for illness, and fast scheduling for routine exams and such, and generally you can self-refer to a specialist.
Imagine that, a plan and clinic system that thinks patients know what their complaints are and can choose the care they need. No seeing a GP to have her say “yep, indeed your nose is a mess, go see an ENT in 4 weeks, now that you’ve paid me $165.”
I’m stunningly satisfied with my care provider and insurance – they’ve never questioned a bill or benefit. I am getting buffeted by recent surges in insurance costs, a double whammy of hitting a new age level and the general COLA rise. But so is everyone else, form what I hear all the time.
Hopefully there will be a Health’bama Care Partners option in a few years. I’d sign on.
Tim, Interrupted
Hell to the yes.
kdaug
@GregB:
Amen.
HyperIon
1. Yes, I would. Most of my medical needs are rather mundane. Asthma, allergies, occasional colds that veer toward bronchial pneumonia. Nothing a CHC couldn’t address.
2. Thanks, Kay, for providing substantive posts that make me think AND are a welcome alternative to some of the stuff being written by frontpagers here now. Also you don’t seem to attract the knuckle-dragger and/or attention whore commenters that have been dominating the war threads…yay!
ericblair
@Legalize:
You’re often dealing with people who are stressed out, with little flex in their schedules, and likely don’t get a lot of reward out of daily life. Junk food is readily available basically everywhere and all the time (food deserts are real), and fast. And when you’ve had a long, shitty, stress-filled day (like, for example, yesterday and the day before that), might as well get a little lift out of a cheap treat and fuck the beans and rice. If you’re in for a little reading, “Road to Wigan Pier” by George Orwell is a great look at daily pre-war English working-class life; the cheap treat aspect was a real factor for a lot of people.
Frankly, if your life relentlessly sucks, assuring that it will last a lot longer by making it somewhat less fun might not the automatic win that us comfortable types make it out to be.
Davis X. Machina
@ericblair: Ta-Nehisi Coates, who knows this joint from the inside, always maintained that it was the cheap treat aspect that was driving the bus….
Ruckus
@kay:
Over the years I have liked to have a Dr that when I show up they actually know me. But it has never worked for more than 2-3 years because the Drs change practices, insurance they accept or they simply move some place nicer. (I also had one pass away at a young age) So I have accepted that primary care is going to be a 5-10 minute interview with immediate diagnosis and a prescription. I don’t think that works if one has chronic problems, although for many it is fine.
HyperIon
@ericblair:
Yes it is.
And I guess you should know, Mr. Blair. ;=)
I haven’t seen you around these parts much lately.
Cris
I see right through your shameless self-promotion from beyond the grave, Blair.
Edit: jinx @HyperIon
Cris
I’m a bit conflicted. I’m not particularly attached to my GP, but I do like her. And if I switched to the community model, I’d be afraid of the likelihood of getting somebody whom I liked a whole lot less.
I guess I tend to come down like RosiesDad: I’ll take the random lottery pick for the annual wellness checkup, but once it comes to a needed procedure I want to have more say in the matter.
Catsy
If only.
Profit has no legitimate place in the access to or approval of basic, essential health care services. The end game here should be to completely eradicate the for-profit health insurance racket as a business model.
Let people buy “Cadillac” plans or premium services if they have the money to do so. But basic, essential care should be considered a universal public good just like police and fire response are most places.
Don’t want your tax dollars to go to providing health care to strangers? Tough shit: I don’t want mine going to fund wars or abstinence-only misinformation. It’s not a menu; suck it up and deal with the fact that you have a civilization and everyone has to pay for it.
ericblair
@Cris:
Heh. I enjoy his essays more than his novels, really; there’s a lot of lefty gold in them thar hills. His fiction works also are thinly veiled essays, too. Besides the obvious, there’s one on private schools that’s pretty relevant now (A Clergyman’s Daughter).
For you Obots, Road to Wigan Pier also includes whole chapters of gratuitous hippy punching (well, Soshulist punching anyways).
Ruckus
@Catsy:
It’s not a menu; suck it up and deal with the fact that you have a civilization and everyone has to pay for it.
And live in it. Together.
RosiesDad
@Catsy:
Amen.
PhoenixRising
I would and I do.
Kid has chronic condition that needs to be monitored, wife has 3 chronic diseases that need mess, I’m healthy but stupid so I break bones etc.
Our family doctor runs a clinic. He charges a reasonable house call rate and a super cheap in clinic visit. Until we’ve spent the family annual deductible from our hSA, we pay, so we get to choose. And we like our doctor. Would be happy to pay similar amount in taxes, co pays and etc so that every family could get such quality care…and every FP could be as happy as ours!
Steaming Pile
@Tom Johnson: Think credit unions. For health care.
goblue72
@gbbalto: Oh sweet jeebus you’re right.
goblue72
@Mnemosyne: None of the doctors I’ve seen have been horrible – its just such a factory setting at their centers that they seem to have a lot of young doctors as GPs who move on to private practice as soon as they can, so I keep having to get a new PCP every few years. That and its pretty clear they have a goal to see as many patients as quickly as possible.
I’ve never had a serious illness while with Kaiser – I’ve heard mixed stories.
gex
@Cris: You have it half right. Blaming the unfortunate is only part of it. You also have to be absolutely certain you are worthy of the advantages you have because you are smarter and work harder.
gex
@Legalize: I would just add that this is complicated. Unhealthy food may be more convenient. But if you work multiple jobs and are short on time or have transportation problems it is more than just an inconvenience. I don’t know that what is readily available to me in my suburb holds true for people in different circumstances.
gex
@RalfW: You remember Allina in MN right? It gives a clue as to how “non-profit” health insurance works. Lots of perks and junkets for execs, as I remember.
RalfW
@gex: That was a problem. But Health Partners seems a lot more transparent, well run, and not a rip-off. But I could be wrong, they and their auditors could by lying out their butts.
BC
I did go to a community health center when I lived in Montana. I figured they were helping people in the community who didn’t have insurance, so if I went with my insurance paying it might help them out. I had great care – but then I have excellent health and just needed the once-a-year appointment.
Three-nineteen
My PCP is so busy I never can get a fast appointment for non-emergency health issues that come up (sinus infection, for example). Even when I schedule a check-up, I see the physician’s assistant, not my PCP. So, I go to an urgent care clinic for everything I can instead of the emergency room. It works just fine, takes my insurance (I think they call my PCP for a referral before I get to the appointment, it’s part of the same conglomerate) and I get competent care. If a non-profit care center works the same way, I would definitely use it.
Wolfdaughter
@Starfish:
I know this will be hard to believe, but the Arizona DMV is actually very well-run and efficient. I go to the main Tucson DMV office. Yes, you have to wait for a while because this office serves all of southern AZ for anything beyond renewing drivers’ licenses. But they have plenty of chairs, and they have a triage window where you state what you need to do, and then they give you a number.
Also the Post Office is run decently.
I think some people just expect to walk into a busy office, be it government or private enterprise, and be waited on RIGHT NOW. And if they see a couple of employees talking, they just assume that it’s not job-related.
Wolfdaughter
@Cris:
Naw, the glibertarians would ask why they should be robbed to pay for someone else’s care. Ideas like herd immunity as a result of enough people in the community being vaccinated don’t occur to them.
It is true that if you pressed them about MacDonald’s or Walmart, they would answer glibly that these people just have to go out and look for the better-paying job with better benefits, said jobs just hanging on trees for the plucking, of course. Or start your own business (with all those benefits you can immediately afford.) While simultaneously whining about public sector employees being grossly overpaid and how the glibertarians’ tax $$$ are going to support these peoples’ bennies when they don’t do any REAL WORK. So go and get that great job in private industry but NEVER work for the gubmint because they don’t generate money.
And if you have a few kids and an ailing elderly parent to care for, you of course can pick up stakes and move across the country for that plum job in private enterprise, which will NEVER be outsourced! It’s a free country! USA! USA! USA!
Wolfdaughter
Kay:
To answer your basic question, yes, I would (and have) gone to a community health care facility, where I was seen much more promptly than in a busy ER. The facility I visited isn’t capable of dealing with more serious problems, but for checkups, small injuries, strep throat and the like, they are just fine.
I am also a veteran of ERs. Both for myself and waiting with friends. In a large city like Tucson, you do have to wait for a long time if your problem isn’t likely to kill you immediately. Especially if you (God help you) encounter your problem on Friday or Saturday evenings with all the driving accidents most likely to happen at those times. And as others have pointed out, the Repubs’ answer to our healthcare crisis is to further burden said ERs.
I am all for getting rid of the profit motive in health care because it severely distorts motivation. I’ve been denied coverage arbitrarily for things like x-rays in particular. But I’m reasonably well-off and can afford to pay some coverage out of pocket. I have friends, though, who would have real trouble coughing up $100 or so for an x-ray.
Ultimately, it would cost us all less to have health care for all, spread over the population base for payment via taxes. I want to see all people getting decent health care, not just for altruistic reasons, but because the healthier the community you live in, the more likely that your health will be better.
My personal ideal would be a community healthcare center which does soup to nuts health care, except maybe for rare diseases which would continue to be treated at medical schools, as is the case now for those diseases. With PC docs, nurse practitioners, etc., and most types of specia1ists under one roof, with MEDICARE type of coverage extended over the entire population, and private health care for the “optional” types of coverage.
Another Halocene Human
@Wolfdaughter
Libertarians are ignorant about economics AND physical sciences.
Just check out the boobs on imminst and other “life extension” and cryogenics (the cult, not the biology technique) websites. Ghoulish, deluded, incompetent boobs. (And that’s an insult to Order Aves.) Many of them literally think: a) they can actually pump refrigerant into their brain at time of death and it will magically preserve their identity for eternity and b) the super-world of the future (your tax cuts at work) will wish to awaken them.
It would be funny if they weren’t abusing the law which allows you to donate your body to science. What they run is an unlicensed mortuary/chop shop. Sooooo slimey (and check out their finances on Rick Ross’ Cult Education Forum). A fool and their money … sucker born every minute … can’t go broke underestimating the intelligence of the American people … etc.
Based in AZ, libertarian and mortgage fraudster Paradise.