A Workable Government Health Plan

Elephant Seal Pup at Peninsula Valdez - photo by JoAnn Sturman

by Ed Lembert, M.D.

The majority of Americans have private health insurance plans or are covered by Medicare or Medicaid. The costs of medical care is rising dramatically in this country but that is a problem which will not be addressed here. What will be addressed is how to cover that portion of the population who currently do not have any health care coverage. Just how many of us that fit that category is a matter of contention.

The White House reports that 46 million people are uninsured. However, 9.7 million of those are not US citizens. Another large portion of the uninsured could afford insurance but chose not to obtain it: 17.6% had incomes over $50 K and 9.1% had incomes over $75 K (the latter group is the fastest growing of those uninsured). Another 14 million were eligible for a federal health program but simply haven't bothered to enroll. Subtract further another group of uninsured who were between jobs or temporarily uninsured at the time of the survey, and the actual number of citizens truly requiring health coverage who could not afford it is closer to 8.1 million. No small number to be sure but not nearly as daunting as the 46 million that the administration claims need our help. How to encourage, entice, or force those who neglect to insure their health is a topic for another discussion. Here I wish to address the truly needy who do not have access to health care because they are either not wealthy enough to afford private insurance or are a bit too wealthy to qualify for public assistance.

I think most of us feel some moral obligation to insure those among us who cannot afford private insurance and have limited access to health care. If we agree to that premise then two questions follow:

1. What level of health care are we morally obligated to provide?
2. How are we going to be able to afford it?

If we aspire to provide every indigent American with the same level of health care that, say, Nancy Pelosi receives then the answer to question number two is "never." We must first acknowledge that there have always been different levels of health care in this country and that some enjoy wider benefits, better doctors, and better facilities than others.

The current levels of health care coverage in America are as follows:

1. The president, Congress and all federal workers, who by no coincidence are "immune" from the burdensome details and limitations of Obamacare.

2. The Unions who bargain for some of the best medical plans available and get more than their "fair share" of Obamacare waivers.

3. Coverage for individuals or through private businesses such as PPO's HMO's and the like.

4. Medicare which has been relentlessly cutting doctor and hospital fees to the bone and making access more and more difficult to obtain.

5. Medicaid or Medical in California which generally doesn't reimburse the level of cost to provide the care it "covers." It forces those with this coverage to go to government clinics or low quality "Medicaid mills" where both the patient and the government get ripped off more often than not.

6. The VA system which is in a close race with number 5.

7. The Uninsured, who now must go to vastly overcrowded public facilities or endure obscenely long waits in crowded private emergency rooms, where they must be accepted and treated regardless of ability to pay absurdly expensive fees.

We simply cannot afford to provide every uninsured citizen with the same level of coverage that Donald Trump, our Congressmen, or even the average working citizen expect. That level of health care is, arguably, the very best in the world. We should not feel obligated to provide every indigent person in America with "executive" health care. What we should do is provide a place for the uninsured to go to get basic medical prevention and treatment. A no frills, low cost type of coverage that incentivizes those utilizing it to aspire to a higher level of care.

This can be accomplished without busting the budget or downgrading this nation's top notch care that most of us have come to expect and trust and which attracts people from all over the world who come here for specialized treatment.

Here's how we can do that:

· Establish local clinics all over the country. Use those already in existence. Expand the system to include walk in clinics, VA hospitals, and active or closed military bases. Add storefront clinics in under served neighborhoods by utilizing the abundant vacant commercial space now available.

· Staff these clinics with medical students, salaried interns, residents, nurse practitioners, physician assistants and other allied health care professionals. Upon finishing their training every MD, DDS, NP, or PA must serve 2 years in one of these clinics as a way of paying back the heavily government subsidized education they received. During the Viet Nam War virtually all doctors were obligated to serve in the armed forces even while their non medical peers got the "Greetings" letter only if their lottery number came up. So singling out medical professionals to mandatory public service and paying them a reasonable salary is not unprecedented.

· If a clinic patient requires a higher level of health care than the local clinic can provide, they are bumped up to a public hospital, a VA hospital, or even a private hospital. If an even higher level of care is needed then they are transferred to a University Hospital.

· Uninsured citizens will still show up at private Emergency rooms but the ERs would no longer be obligated to provide treatment as they are under current law. Private ERs would be allowed to inquire as to ability to pay (right now they are not even allowed to ask this question). The private ERs would be required to triage uninsured patients and shunt them to the local clinic, provided life saving care is not necessary.

· There would be NO eligibility requirements to receive treatment at these clinics. This would save oodles of money that is now being wasted to "screen" Medicaid applicants for such things as personal assets, citizenship, etc. You walk in, you get treated. No questions asked. An army of "eligibility" workers immediately are freed up. Chances are that anyone who can afford private insurance will not go to these clinics where the facilities are far from plush, the wait probably substantial, and the staff consisting mostly residents and allied health professionals.

· And one more very important factor: The patients who utilize this system are not allowed to sue their medical practitioners for malpractice just as military personnel and their families cannot sue military doctors for malpractice. They may, as is the case with military personnel, have the daunting right to sue the Federal Government but not the clinic workers. This will save a bundle on defending frivolous law suits and, more importantly, would all but eliminate the huge cost of providing "defensive" medicine.

Trying to "mainstream" the millions of uninsured Americans into top notch health plans is not fiscally feasible and would force a downgrading of coverage and accessibility for most of us who are paying our own way right now, but you can bet Congressional members will continue do just fine.

This is not a plan to save Medicare which is another story. It is a plan that will meet our moral obligation to provide basic medical care for our indigents without ruining the best health care in the world or breaking the bank. Would the indigents receive the same gold plated health plan that Harry Reid gets right now? No, but they never have had such coverage. For that matter the rest of us "ordinary citizens" haven't had it either.