This article was written in response to the following blog post:
“I live in Burlington and I only know about health care here. It is overcrowded, inefficient and expensive even with health insurance. Also, if you wait long enough, your problem tends to go away. I support Bernie Sanders getting more money for the Community Health Centers, like the one on Riverside Ave, to take pressure off ER visits and provide routine care for uninsured. However, I feel we need torte reform (please lets have a list of what body parts are worth, with the maximum being death $500K?) and we need to expand family doctors, physicians assistants and nurse practitioners ( I would love to see them available at Drug Stores and the supermarkets- one stop shopping) first or the costs will overtake the State of Vermont. Too many Vermonters are out of shape and overweight. They need nuitritional guidance and an exercise coach. Not to even mention how many young people smoke and drink to excess. What consequences are there if your Dr says you need to lose 50 pounds and exercise and you don’t? Will you be fined? There should be financial incentives for those who are healthy and lead a healthy lifestyle and those who don’t. I also believe in buying insurance across state lines and in picking the plan that suits you, similar to auto insurance.”
First, health care is “overcrowded, inefficient and expensive” because of the overload of State regulation now and for many years prior.
Second, rarely anyone asks the price of any procedure or office visit now because someone else is paying (state, ins. co.). The only way the govt. will cut costs is to cut services and provider payments. I don’t know what you do for a living, but I have no interest in voluntarily taking a huge pay cut and work at my job for less than my peers in other states (especially if I had invested years of my life and a bundle of money on an education and staying current in my profession); then on top of this reduction, take an additional cut in my net pay to hand over more in increased payroll taxes. For further insult, if I choose or need to see an out-of-state doctor, I will likely have to pay cash for a triple whammy.
When the ‘free, universal, single payer (whatever the brand of the day) health care ‘plan’* kicks in, more people will be scrambling to see the doctors that are left. It doesn’t take a mathematician to see that the two sides of this equation won’t balance.
I like your idea of one-stop shopping except with the new socialist way, the shopping will be done by the govt., and likely, we will be told which one of “Bernie’s Clinics” will oversee our health care in our region….no shopping required. When ‘shopping’ for price and quality (knowledge, experience) are eliminated, the odds are very, very high the price will go up. I believe non-shopping is currently a contributing factor in high prices. Very few ask how much or compare the price with another facility offering the same service, and the price varies considerably.
Ever try to buy fresh tomatoes in January? Well, try to buy fresh tomatoes in January from the only store in town (Bernie’s) at which we’re allowed to shop– with the caveat that we must have them or become sick. Those tomatoes are now very valuable and/or sold out (lines, no service).
Lastly, dictating what Vermonters do with their personal lives is quite a scary prospect; it makes the hairs stand up on the back of my neck. Many doctors don’t want to broach the weight subject. They call it a ‘social problem’. Addictive behaviors are best dealt with by the mental health community (alcohol, drugs, food), and people can only seek out those services when they are ready to make a commitment to change or are ordered by a court (crimes).
How do we force a poverty stricken or wealthy or overweight or depressed or addicted person (or any combination thereof plus) to seek medical care? If incentives worked, we would be void of alcoholism or heroin addiction, and all the addicted persons would be working, getting a paycheck, and living in harmony with the families whose lives they adversely affect.
What kind of incentive would make John or Jane Doe change, when the love of their own families (children) isn’t incentive enough? If money were the answer, there would be no celebrity rehab.
Years ago, I recall reading about one State (city perhaps) that screened all welfare recipients for depression, treated it, and moved people out of welfare. Perhaps, that would help if it could survive the ACLU.
It sounds like you believe in the free market, and torte reform, but I’m sure that’s not what Bernie has in mind with his health centers. Encouraging physicians to move to Vermont by de-regulating and competing with other physicians is what will drive health care costs down. Also, we must have a direct financial investment in our own care or what incentive would we have to modify un-healthy behaviors and keep the body in good condition? Have you ever let your teenager borrow your car?
When Peter Shumlin says ‘everybody will pay’, we’ll pay alright.