What to Expect from the Health Care Delivery System Within Ten Years, and How to Prepare for It
Site Member, M.D.

March 23, 2010

Are you REALLY prepared for National Health Insurance?

I feel the need to provide a first hand description of my experiences with true national health insurance in light of all the discussion regarding a government option. Many believe that the government taking over health insurance would be a reasonable thing to do but more than any other issue today this falls under “you really don’t have a clue.”

First, let me preface this with the fact that I was raised in a northern European country that had national health insurance and experienced it first hand for many years. Secondly, I have practiced medicine and surgery for more than 3 decades in the U.S., so I have some insight as to current health care systems and reimbursement policies. Lastly, I do not pretend to have all the answers except that a government-run plan is a certain prescription for disaster to the uninformed and unprepared. If you disagree, ask the well-off Europeans why so many have very expensive private health insurance policies.

First off, when a national health insurance plan is in place, by definition the doctors and hospitals will get lousy reimbursement. So bad in fact that no doctor will voluntarily accept a fee for service plan (where you get paid for each patient you see – it also implies the more patients you see the more money you make.) So in order to prevent wholesale boycotting of the plan by all physicians and hospitals, they will come up with some program that each doc gets a stipend based on a certain number of patients they must be responsible for. If this sounds familiar it was called capitation in the 80’s and 90’s and failed miserably in the U.S. But it will probably be legislated and the states will be required to tie participation into the doc’s license. The key to this is you get your money whether you see the patient or not.

Back to the European experience. So, you are sick and need to see your doctor. Notice I said “your doctor” because you have no choice — you are assigned a doctor and good, bad or indifferent this is the guy you MUST see, no exception. So you call for an appointment — oops, there are no appointments. You have to to his office and see him when he is available. So assuming he is available you go in and register. You now sit on the bench and wait for your turn, no matter how sick you are. Now, remember that there is no incentive to see lots of patients? So the doc is relaxed, takes his time, takes care of minor problems for the patient he is seeing such as wart removals, counseling etc. no matter how many patients are waiting. Then, when he is good and ready, he calls for the next patient. Lunchtime rolls around and the doc leaves. Still patients in the waiting room? Feel free to leave if you don’t like it – gamble that things will be better after lunch. Or else keep your place in line and wait though lunch.

So, you have been waiting all day, and it’s about 4:00. The doctor has had a hard day and is going home; he tells the nurse he is leaving. If there are still patients in the waiting room, they are told to come back tomorrow, or else you may go to the local hospital. If you choose this option, you are treated by the “house physician” who generally was not considered competent enough to have his own practice. Need urgent care? Let’s see if you have “the will to live” until morning. Need an imaging study to diagnose your problem? Sorry, only 2 CAT scans are allotted per day — the next opening is in 5 weeks. Are we having fun yet?

The last piece of the puzzle will be true liability protection for the docs. In other words, in order to get buy-in from the medical associations, the docs will all get the same protection as a military doc, who cannot be sued personally for medical malpractice mistakes — you only have the right to petition the government for relief. So, now you will truly get to discover what the term “practice of medicine” will mean — the docs practice on you until they get it right. So, very little oversight: let’s try this new procedure I read about, let me prescribe this drug off-label and see what happens — you get the picture.

This is a preview of the personal experience with national health insurance. I have not even begun to discuss the legislative fallout. For example, although there may be outrage about the “death committees” and rationing, anybody who thinks they will get otherwise is living over the rainbow. Over 60 and need a kidney transplant? Sorry, we have determined it is not cost effective to give transplants to you after age 60. Need the latest expensive chemotherapy because standard regimens have failed. Sorry, the drug is not on the approved national pharmacy list. Need a total hip for mobility due to advanced arthritis? Sorry, the limit has been reached for total joint surgeries (it IS March already you know) so here is a cane and some Motrin — feel free to join the queue, as it is only three years out so far. Want curative surgery for your localized cancer? I’m sorry, we have determined it is more cost effective to give radiation for most cancers of this type.

These are not theoretical issues; these are actual examples for health care standards in many countries such as England, France, Canada, and Australia.

This is what is in store for the unprepared who believe the government will take care of them. In a pen stroke Medicare and Medicaid will be rolled over into this system. The current uninsured will be required to avail themselves of this option under penalty of legal reprisals.

So, if you have any ability at all to qualify for private health insurance, do so and hang on like grim death to that policy. Do not trust employer policies as these will also be rolled over into national health care (“I’m sorry the guv-mint says I have to do this!”)

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Tags: Nationalized healthcare

This entry was posted on Tuesday, March 23rd, 2010 at 11:55 am and is filed under Health Care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.