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Gift to the Mega-Rich?

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  • #61

    ENT Doc-

    I’m losing faith in a non-single payor system. It has to be done well, but I think that may be the ultimate solution to reasonable costs and reasonable access to care.

    And for heaven’s sake, we need some death panels. All the health care you consume cannot be an entitlement.
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    Tell me the last big government program that was “done well”, didn’t bust through its budget, doesn’t suffer from gross inefficiency (aka waste of taxpayer dollars), and that doesn’t substantially contribute to our national debt.  All programs start with good intentions.  They just never live up to the hype.

    Again, there are smart people out there (many of whom come to discussion boards such as this to discuss and debate).  Can we really not think of ANYTHING that would be superior to giving the most inefficient and incompetent segment of our market power over that which we hold most dear?  Our government doesn’t have a track record that warrants handing it such power.  I’m serious – can anyone here not think of any models of care that would reduce costs that doesn’t involve big government single payer?  I would hope those of us in medicine, with all our wit and wisdom, would have devoted some time thinking about how to accomplish this task.  Any takers?
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    I’ll bite.  The cliffnotes version of my plan:

    1) National healthcare plan, Medicaid for every legal resident, birth through 80 years of age.  You get fired (after 3 warnings) if you abuse it (ambulance for your 20th ER visit for belly pain, 3+ visits for alcohol detox–I saw 2 of each of these patients today).  This also includes folks that don’t take their meds, maintain an unhealthy weight, smoke, etc.  Yes, this lifestyle stuff is vague and would need rigorous protocols.  Even if we find the discussion awkward, accountability needs to play a role.  I’d like to have mandatory hospice/comfort care (the nefarious death panel), but I don’t trust who would be in charge of that.  Perhaps low hanging fruit, like if you are a Child’s C or have CRF with no plan for a transplant.  Providers are covered as government employees for purposes of medical liability.

    2) Private insurance.  You are welcome to pay for this as a supplement to Medicaid or if you lose your Medicaid.  If you want to to get dialysis for 10 years, or get your massive transfusion protocol for your bleeding esophageal varices, this is your option.  You will get that knee MRI faster, the fancier surgical post-op lounge, maybe even a fancier and faster surgeon.  Yes, this will create two standards of care.  I am pretty sure that if Lebron James sprains his knee, he gets a different standard of care than me; I am comfortable with this.  Providers must buy their own malpractice.

    3) Self pay (as in actual cash or credit card) for those that get kicked out of 1 and can’t afford 2.  This is where charity comes in, either through provider care or from donations like RogueMD who wish to earmark money for healthcare but not bunkerbuster bombs or the USS Donald Trump battleship/dinghy.  Providers are covered under good samaritan laws.

    4) You get nothing.

    Of course this is going to be expensive, but I suspect there would be “savings” realized in the rationing of care, specifically no more wasting money on futile care that could be instead funneled back to preventive health.  Heck, maybe there’d even be enough left over to give extra to education and infrastructure.

    Perhaps this is all too callous, but our current system doesn’t feel sustainable as presently we seem to guarantee that everyone gets everything they want no matter what.  Particularly when combined with the boomers starting to have their age catch up with them and an entire generation of children that are demonstrably less healthy than their parents were.

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    I'm getting the feeling that you don't think addiction is a medical condition?