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THE PUBLIC OPTION |
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THE DOCTOR IS NOT IN THE HOSPITAL!
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THE PUBLIC OPTION |
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THE DOCTOR IS NOT IN THE HOSPITAL!
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ALSO |
THE PUBLIC OPTION |
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The embattled Public Option, misunderstood and often misrepresented, already exists in the form of the 8000 Federally Qualified Health Centers (FQHC) that are scattered in various communities throughout the country. The Centers are created through Grants from the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) to communities that apply. Initially conceived to provide medical services to the Medically Indigent under the Truman Administration their doors are open to all Americans with fees adjusted from zero to the ability to pay. All insurance is accepted. If your doctor is out of town one of these Centers might be preferable to visiting the neighborhood Emergency Room. These Centers interact with the Private Sector exist side by side with HMOs and most important are entrepreneurial, they earn money, they are in the medical business. These Primary Care Centers are uniformly staffed by a: Pediatrician Primary Care Specialist (general practitioner) Specialist in Internal Medicine Gynecologist Obstetrician Dentist The average budget for each center is about $3 million per year, 1/3 paid through Federal grants, 1/3 contributed by State governments and community enterprise, and 1/3 from re fees charged for medical services. 1 Unfortunately not all bills are paid fully. The shortfall in reimbursement revenue is enumerated in the table below. 2 Health Center Patients % Gap in Payments $ Millions % Medicaid $ 5.7 35% -14.9% Medicare $1.2 08% -28.0% Other Public $ 0.4 03% -34.4% Private Insurance $2.5 15% -42.5% Self pay uninsured $6.2 39% -77.6% _____________________________________________________________ Total Shortfall $16.1 M 100% Average % Shortfall -39.6% In 2007 the failure to reimburse fully created a deficit that would have funded 5 additional Centers. The Primary Care Centers are akin to Single Payer in the sense that the medical staff is salaried, but differ in that the government shares costs with contributions from the community they serve, and the Centers earn about 1/3 of the upkeep from the patients they see. The DreamTeam hopes would be enough Primary Care Centers to satisfy the needs of the country 24/7/365. Budgeting to create and distribute such Centers over the next 10 or more years will: Assure the availability of Primary Care Medicine to all Americans Avoid prolonged Congressional debate Remove from HMOs much of the burden of Primary Care Decongest Emergency Rooms Provide a platform for a comprehensive Health Care System Create millions of jobs Mitigate malpractice litigation Lower Health Insurance costs for those less than 65 years of age because the costs of primary care would be pay as you go, ranging from no fee at all to what one can afford personally or through insurance. The fact that these centers are entrepreneurial should help remove the stigma of “Socialism” so many seem eager to apply to anything that involves government. Although the Centers are available to all, citizens are free to utilize whatever primary care source they prefer. They can visit Centers as need be in an emergency, after which follow-up care would revert to their original doctor or clinic. Because the medical and nursing staff is federally employed litigation is mitigated by the Federal Tort Claims Act (FTCA) that designates the office of the Attorney General of the United States as the Attorney for the Defense. Creating adequate numbers of Federally Qualified Health Centers, each with specialists in one of 5 Primary Care Specialties would certainly reduce the costs of referrals because more of the needs of the patients should be satisfied on site. Instead of simply writing prescriptions and referring patients, Primary Care would be enhanced its scope expanded (as required by the Auraria CO Health Care Center) to include beyond history and complete physical examinations:
Minor
surgery Basic rehabilitation for musculoskeletal injuries General Dermatology General eye problems and Use of Slit Lamp on site General EKG interpretation enough to refer patient if EKG indicates Emergency management skills use of defibrillator on site Allergy shot administration General GYN expertise Obviously with those skills practiced in a Primary Care setting referrals would be significantly reduced. Instead of exporting these patients for a cumulative fee of $100 per category, the revenue for each happenstance would be received by the Center. Before slicing and dicing the Health Care System and conjuring mysterious and possibly injurious ways to subsidize it, the components of Medical Practice must be analyzed and the construct of good medical practice defined. This might avoid the public defamations that defile the current debates. As I understand it much of the debate about Health Care relies not so much on cutting costs as coercing or forcing larger numbers of citizens to enter the system so that Health Care will be better funded. That is not the way to provide better care or improve matters. Too often we hear talk about “reforming “Health Care”. What is needed is a better “flow chart” of patient care. The Practice of Medicine can be divided into 5 major components Primary Care; Specialty Care; High-Tech Care; Hospital Care; Long Term Care While high tech medicine has absorbed technical advances and is practiced with exceptional expertise, Primary Care has been deconstructed, surrendering too many of the tasks that properly form the Job Description of that specialty. Primary Care must be rescued from the confining environment of the HMO Panels to assume its principal role in the Medical Hierarchy. Primary Care is the Hub, the Foundation and Nexus of any successful Health Care System. Ideally and Properly Practiced Primary Care Physicians (Captains of the Ship) direct and control the care of their patients. They must take comprehensive histories, perform complete physical examinations exploring every orifice, and be practiced in the Primary Care Procedures described above as required by the Auraria Health Care Center. In addition, patients referred must be returned to the Primary Doctor with a full report. The Consultant cannot refer to another Specialist without the express permission of the Primary doctor, nor perform serious procedures without notifying the referring doctor. In other words, the Primary Care Physician manages the case. This protects patients from unnecessary or repetitious referrals, or from being rushed to a surgical procedure. A Table of Organization of this sort will save money and provide optimum care for the patient. Because all of the Primary Medical Centers will be connected on the internet conferencing and consultation will be simplified and save time. Patients travelling will be welcome at any center in a distant city. A fringe benefit of this inter-connectivity is the fact that doctor-to-doctor talk is exceedingly educational at both ends of the wire. Complaints that the system is too costly and often unaffordable are true. Total costs for 2007 were 2.24 TRILLION dollars. The money would be better spent were Health Care organized around Primary Care and specifically flowing from the Primary Care Centers. Medical, Surgical and Hospital services comprised only 52% of the 2.4 trillion dollars spent on Health Care in 2007.
click Black Box to see pie chart Back or Back Arrow I believe that the system can be rejuvenated by populating the country with Primary Medicine Centers. As stated above each Primary Care Center costs 3 million dollars a year to maintain. The cost of the 8000 now functioning would be: (3*106 ) * (8*103)=(24*109 )=24 billion dollars. 100 Billion dollars can create about 33,300 Centers. I don’t know the optimum number we need to satisfy our medical care needs, but over time 1 trillion dollars would create 330,000, or more than 6600 for each State in the Union that will assure comprehensive Primary Care Medicine for every citizen 24/7/365 and create at least (25 per unit) 7,500,000 (seven and a half ) million jobs. We have become mostly a Service and Information Economy. Health Care is high priced Service. In the meantime the Congress has voted perhaps 10 billion dollars for the creation of these centers from now until 2020. Not nearly enough. Once everybody in the country is assured primary care the problem of long term insurance must be addressed. HMOs should continue to be the domain of Specialty, High Tech and Hospital practice. Perhaps a system of Term Insurance Policies might evolve that would protect young families for say a 10 year terms giving the family time to get its bearings perhaps be able to afford HMO fees or take out another 10 year Term Policy. The costs of the system look big on paper, but every dollar cut from the system reduces a salary and national purchasing power. Were a Hospital to close it would have a more devastating effect than the loss of an automobile dealership. Planning ahead in this manner would be more satisfactory than coercing every citizen by tax rebates or other bribes to become “insured”. Better the rebates be assigned to creating effective comprehensive Primary Care. 1. Personal communication from HRSA 1.5 Million for the facility (this will vary according to the location of the health center); 1.0 Million for staff ; 0.5 Million for governance costs (this is probably fairly standard nationally) 2. Geiger Gibson/RCHN Community Health Foundation Research Collaborative Policy Research Brief No. 11 (GW University Community Health Foundation)
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