THE PUBLIC OPTION
As specialties burgeoned the General Practice of
Medicine became increasingly restricted—why not? As Medical Practice became
proportionately complex and medical
research brought new tools, medicines and products to the fore it became
difficult and finally impossible for a General Practitioner to become a master
of all specialties. The lawyers rapidly discovered this money trough and
encouraged disgruntled patients to seek their services. “After all, did the
doctor refer you to a specialist in a timely manner?” These changes induced the
GPs to narrow their fields of endeavor. It was dangerous to perform a specialty
activity in the absence of having achieved Specialty Board certification.
Specialists charged more than primary care or family doctors, and patients were
chary of too many referrals. But Health Insurance diminished this hesitancy,
and it became easier and safer for the Family doctor to refer to specialists
than to compete with them. Currently the family doctor is in short supply and
too often regarded as the gatekeeper who does little other than refer and write
prescriptions. Yet the properly trained the Primary Care Physician is the
foundation and fulcrum of the profession of medicine. That field must be
rejuvenated so that at the very least the doctor is competent in practices as
specified by the Health Center of Auraria CO.
The doctor
must be proficient in Minor
surgery, Suturing
Fine needle aspiration
Casting/splinting
General orthopedic Evaluations and Management
Ability to read x-rays or the x-ray reports at the very least
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 indicated
Emergency management skills use of defibrillator on site
Allergy shot administration
General GYN expertise.
Try to imagine how many referrals would be saved with
practitioners like that on the premises.
The issue of Primary Care, the Uninsured and the
Public Option could be resolved were the Government aggressively add many fold
to the 8000 Primary Care Centers of America currently scattered about the land.
Originally
established to provide medical care for the medically indigent, Primary Care
Centers are staffed by specialists in Pediatrics, Primary Care, Internal
Medicine, Gynecology and often a Dentist. The Centers are community based and
funded by grants from the Feds through HRSA. They cost about $3 million a year to
maintain: 1/3 from the federal government, 1/3 from donations by State, and
community enterprise and 1/3 from treated patients. They will take cash,
insurance or treat for no fee at all if necessary. Because Doctors (salaried from the grants)
are federal employees malpractice litigation is defended (under the Federal
Tort Claims Act) by the Office of the Attorney General, a detail that tends to
discourage frivolous law suits.
Proliferation
of these Centers would make Comprehensive Primary Care Medicine and Minor
Surgery available for every American Citizen whether insured or not. Look at
the benefits. Nationally assured primary care; decongestion of emergency rooms,
reduction of malpractice litigation, fewer referrals and side-stepping Congressional
debates.
There is no need for every patient to be INSURED if
all can be ASSURED high quality Primary Care. In this scenario High Tech
Medicine, Surgery and Procedures remain in the domain of HMOs.
Perhaps because they are established mainly in poor
neighborhoods to provide care for the medically underserved these Primary Care
Centers seem to be largely unknown to the general public. Were there enough of
them to satisfy the National appetite for Primary Care, these centers would
become The Public Option. Have them become your family doctor and not be
insured or be insured as the case may be; or use them if your doctor is out of
town, or whenever they may be convenient.
Concentrating on the Cost of Health Care Congress may
end up by forcing every American to buy Health Care insurance come Hell or High
Colonics. It strikes me as a little “pushy” to force each of us to buy Health
Insurance. Health Insurance unlike Life Insurance, costs more for the young
than it does for the elderly. That’s not right. The youth are pulling someone’s
fat out of the fire. Could it be the HMOs? Or Medicare?
Subsidizing Primary Care Centers over time would be the start of a beautiful
friendship between the Public and Health Care. And at this juncture Insurance
Companies might become creative and develop different ladders of insurance that
would add Hospital and Critical Care to complement this innovative Health Care
system for those currently not insured for High Tech and Hospital Care.