Eric wrote what I think is a very good and heartfelt post about Catholic Social Teaching and Health Care Reform. Because this is exactly the sort of substantive discussion that American Catholic was intended to foster, I’d like to see if I can pick up some of the themes which he brought up and explore them specifically from a small government conservative and free market angle.
To start with, I’d like to make a distinction between levels of care, though such things are always slippery because medical science advances so rapidly in our modern world. First, there is basic health care. This includes most of the healthcare which goes on most of the time in the US — unless you’re well outside the norm it’s probably all that you’ve needed within the last year.
Diagnosing standard diseases and infections, and treating them with anti-biotics. Standard inoculations. Basic screening tests. Treating basic injuries. X-rays. Standard ultrasounds and pre-natal care. Delivery in cases without complications. Well-child care.
With modern technology, these are elements of medical care which can be very easily and cheaply provided. They are also comparatively low skill. In all reality, a certified nurse or a pharmacist could deal with many of these situations. Certainly some sort of generalist doctor with a more basic sort of medical training could handle them.
The most humanitarian goal would, I think, be to have this kind of care as widely and cheaply available as possible. In the third world, charitable organizations do this by shipping in trained doctors and interns along with crates of basic medicines and medical technology. In the US, it seems to me there are basically two approaches one could take:
1) Create separate licensing and regulation models for “basic” healthcare, allowing large numbers of clinics to spring up providing these services at competitive rates. Because these services can at this point be provided very cheaply, and allowing this to function on a retail model would push providers to establing longer hours, efficiencies, etc.
2) Create a system for chartering free “charity clinics” run either by the government or by non-profit corporations whose mission is to provide “basic” care for free to anyone who is certified as meeting certain thresholds of need.
I think that of these 1) would probably work much better, and it could be supplemented by a debit-card style payment card which would be provided to people in serious poverty to allow them to use the clinics on a subsidized basis. Basic care would have to have serious regulations on liability, and it would be billed on a retail basis rather than through the whole medical billing nightmare which eats up so much time and expense in our current combined medical system. As such, I’m pretty sure that the costs would settle out to a very low level, allowing all but the very poorest to easily afford their basic care out of pocket. (And for the poorest, we’d want some sort of assistance.)
Beyond this Basic Care would be Advanced Care, which would consist of all of the more advanced treatments for more serious problems which modern medicine allows. This care would be provided through a system more like our own current system. Costs would remain relatively high, but you’d only need it at long intervals. I think the best approach would be to move to an individual insurance approach which covered just Advanced Care, with standard deductibles around 500-1000 per person per year. Because basic care would be taken out of the mix, claims would be much less frequent for any given family. (You might go years without using your advanced care insurance — just as with your homeowners insurance or your car insurance — but it would be there when you needed it.) There would also need to be legal limits on what criteria could be considered in setting advanced care insurance rates. This would raise everyone’s rates a bit (to account for not being able to turn down people with existing conditions or genetic predispositions to certain ailments) but the overall result would be positive in that it would allow everyone to be covered. For the poor, we’d need either a government policy or a system for a combination of government and charitable funds being used to pay for Advanced Care policies for the poor. Other models than insurance could also be tried, including Advanced Care cooperatives which pooled people in a particular region, profession, school or church.
Good post.
I’m part of a project in Madison, WI that is addressing this issue right now. It’s called Our Lady of Hope Clinic, and it will offer free basic healthcare to the uninsured.
How will this be paid for? We are currently recruiting and signing up benefactors. These benefactors will pay a single annual fee to receive all of their primary care from the clinic. What’s in it for them?
1. Their contribution serves the poor.
2. They get high-end concierge-style care. In other words, instead of the average six-minute appointment, they are guaranteed 30-minute office visits so the provider gets a complete picture of their health and their needs. There is 24/7 access to a personal physician. This also allows for a focus on preventative medicine so health care doesn’t turn into “sick care.”
3. Only 300 benefactors per physician–about 10% of the typical practice. This allows for the long appointment times and individualized attention. It also allows the doctors to spend slightly over half of their time treating the poor.
4. 100% pro-life. Parents don’t have to worry about doctors pushing birth control pills on their teens.
5. No billing or claims. The annual fee covers everything.
6. There are tons of tax deduction opportunities, depending on one’s situation.
7. Depending on their current coverage, many people can actually save money by becoming benefactors and switching to a high-deductable secondary coverage for their advanced care.
Certainly the solution to American health care is not singular, but I believe this model will make some serious inroads. It’s a win-win for the poor and the benefactors.
Additionally, it eases the burden on the system. When the uninsured can treat, for example, their diabetes early, it cuts down on ER visits that will never be paid for. This reduces the sunken costs of our hospitals and benefits the consumer.
Oh yeah, if you’re interested in learning more: http://ourladyofhopeclinic.com/
Sounds like a pretty good idea. It kind of reminds me of the stuff Wal-Mart is doing with its health clinics. My main concern is that if these sorts of things become too popular, the AMA will try to shut them down, ostensibly on grounds of safety but really as a form of protectionism for doctors.
How dare you question the motives of the AMA. What’s next, teacher’s unions? The ABA?
When I was fairly young our family got most of our care from a local clinic which worked on something like this model — it was I believe open to anyone who was a city, state or federal employee (my dad worked at a city college) and it was the local clinic at which young doctors did their internships.
And yes, one of the major obstacles to this kind of thing is the AMA, which wants to make sure that the value of doctors (and thus cost of health care) remains high.
How dare you question the motives of the AMA. What’s next, teacher’s unions? The ABA?
Ha!
Diagnosing standard diseases and infections, and treating them with anti-biotics. Standard inoculations. Basic screening tests. Treating basic injuries. X-rays. Standard ultrasounds and pre-natal care. Delivery in cases without complications. Well-child care.
It is an interesting idea, although it may be difficult to distinguish in practice between ‘basic’ and advanced health care. To cite one example, during both of my wife’s pregnancies, either she or the child required more than ‘basic’ care; it is hard to assess pregnancy risks ex ante.
I have had a couple acquaintances (both in their twenties) in the past five years who went to the doctor with fairly minor complaints (a persistent cold, a sore knee) that turned out to be cancerous, requiring prolonged medical treatment. It is possible that a regular nurse or less skilled personnel would have made the proper referrals for a timely diagnosis; but health care is a field where incremental differences in education can matter a great deal. At least, so it appears from the outside.
Given the large number of people who cannot (or will not) pay for basic insurance now, the balance of harms may weigh heavily in favor of relaxed licensing requirements. Any change will have trade-offs, and this is an interesting suggestion. How feasible it is politically is another question entirely…..