Part 2 - The Patients

First let me begin by admitting that I don't have an MBA or even a degree in economics. I haven't hashed out any numbers to see if this plan would even get off the ground, I have no authority to implement my recommendations, I have no illusions that these suggestions will ever become the blueprint for any sort of significant healthcare reform, and I fully expect to instead be led like the rest of you by the yoke of Hillarycare Obamacare over the cliff of doom as we plummet into a lobotomized pile of decaying socialized medicine zombies.

But it's my blog, and I don't have to support my assertions with facts. These are just the ideas of an anonymous ER doc in the trenches, so take them for what they are worth. I'm not breaking any new ground either, so anyone who thought I was going to reinvent the wheel is going to be just as disappointed as the liberals who won't be happy with any plan that requires any amount of personal responsibility or features any amount of inequity whatsoever.

So what is my solution? I'm not ready to tell you yet. But here's some more table-setting:

For the sake of argument, I'll divide people into 5 categories:

1) Healthy people with a few minor chronic medical problems who can afford insurance and want to be protected against the big expense of a surprise appendectomy or heart attack. We'll call this group "the typical family."

Currently, the typical family is doing OK with our current system, and they ultimately will do well with any system that is put in place. They would like to pay less for medical care, but so would everybody else. They have full access to care right now, but they are afraid that any change in the system will reduce their access to (or quality of) care and/or increase their costs further.

2) Healthy people who work and would like to pay something for their medical care, but lately it seems that medical insurance and healthcare costs too much for them. I'll call this group "the struggling family."

The struggling family is struggling, as usual. They have had a recent ER visit that they are gradually paying off (with difficulty), and they are scared of a really big ticket medical catastrophe that might bankrupt them. They would like to be insured, but would accept access to cheaper care if it were available. I'll also place the healthy young working-class uninsured into this category, but they aren't really scared of a medical catastrophe, they are just betting they will stay healthy and will deal with the consequences (for better or worse) if they fall ill. The medical industry and the responsible insured both need to be protected against the ones who bet wrong, because they drive up costs for everyone else.

3) People who think the government should provide everything for them and don't want to pay anything at all for their care. We'll call this group "the gold tooth trauma victims." They can be sometimes be identified by their gold jewelry, their expensive cell phones, or their dripping bodily fluids. Age 16-30 for the most part, their medical conditions are often self-induced.

The gold tooth club doesn't give a shit about healthcare reform, because they ain't paying nothin' anyway, foo. They give fake addresses, refusing to show ID so that we can't bill them, and they throw away all the prescriptions we write except the vicodin. They'd rather get a shot of antibiotics for their crack-induced bronchitis so they don't have to pay for a prescription.

The medical industry would like to get paid for our often expensive treatment of these patients, however, so we are the ones who need some help from the government in this case. These patients are putting a strain on the system, particularly on the inner-city county hospitals that are the true safety nets of society. They also drive up the cost of everyone else's medical care.

4) Chronically ill people with diseases that require frequent or expensive healthcare visits and are currently uninsurable. I'll call this group "the dialysis patients."

The chronically ill dialysis patients are all covered by Medicare and/or Medicaid, so they actually get outstanding medical care. Others who are chronically ill, for example the multiple sclerosis patients or the rheumatoid arthritis patients who don't quite qualify for disability and can't get medical insurance, are in more of a bind. They can't afford their Tysabri or their Remicade for much longer, and an ER visit or hospital admission is a financial disaster for them. They hope that whatever healthcare reform is passed somehow creates more Rheumatologists and Neurologists and also somehow requires their fellow citizens the government to pay for their expensive medications and therapies that they are increasingly unable to pay for themselves.

5) The poor, the children, and the disabled

Truly poor and disabled patients are already covered by Medicaid, as are poor children, otherwise they may fall into one of the above groups. The sick children of struggling or sick families occasionally fall through the cracks of our current system and deserve a solution.

So what are my solutions? Sorry, I'm going to have to string you along a bit more. These posts require a lot more thought than my typical "Ooh, look at this gross chunk of butt wax" post. I'm almost finished, but I'm still polishing it up a bit. Most of you aren't going to like it anyway, so don't get too excited.

Part 3