From the Chicago Tribune: Nursing our way out of a doctor shortage, discussing the doctor shortage that will become much, much worse in a few years when Uncle Sam starts subsidizing the insurance industry and expanding medicare, and suggesting that regulations be relaxed to allow more people to seek treatment from nurse practitioners. I’d love to see that, along with some tort reforms to reduce unnecessary CYA medical practices, of course. In my ideal system, I’d be able to buy some kind of health insurance that only covers catastrophic, unexpected illness or injuries and I pay out of the pocket for routine maintenance.
For me, it’d work great: I rarely get sick, and when I do, I know what it is and how to cure it. The majority of working-age people are like that, too, and if we could pop in to see a nurse, explain our medical history and how long we’d put up with the symptoms to confirm a bacterial and not a viral infection, pay out of pocket, then walk out with a prescription for a Z-pack, the medical system would be humming along smooth as silk. When I busted my face up last year, I paid out of pocket and got over $600 worth of discounts for paying cash. The cost of the repair ended up being about the same it’d take to fix my car if I’d hit a side panel that hard, so a reasonable price.
The big problem with the healthcare discussion today look to me that everyone wants “someone else” to pay their costs (when there is nobody else, there’s just you and people like you) or we think that we can pay insurance companies substantially less money than insurance companies pay for our healthcare. We’d be better off with less insurance and more doctors and nurses, but we’re committed to head in another direction.
Another thing from that story: it mentions the health-clinics run by the CVS and Wal-Greens drugstore chains. That’s a brilliant idea that I only recently heard of from a friend in St. Louis. There aren’t any in my area yet, but once they show up, I’ve pretty much got what I need, except for the whole health insurance for unexpected problems part, which I wouldn’t be able to buy because of state mandated minimum coverage.
In other medical news, this is exciting.
I kind of think the student health system is the ideal: pay a set fee for access to a McKinley that treats the colds and warts and minor stuff (it would be fine for it to be staffed with more nurses and fewer doctors), and then pay more for outside care if it was something the health center couldn’t cover. I feel like it does a pretty good job of separating the routine and cheap from the exotic and expensive.
I really don’t like the idea of paying out of pocket for routine visits (which I’m sure I’ll have to do as soon as I leave U of I) because it unfairly penalizes people with chronic yet simple conditions. Like you said, I can usually diagnose and treat myself, but the medical establishment doesn’t trust me to do so. If I’m going to have to see them as the gatekeepers for what I want, I don’t want to pay extra for the privilege of them getting in the way between me and my treatment.
I let them take out my thyroid for alleged cancer, so I have to be on thyroid hormone for the rest of my life. For practical purposes, thyroid hormone is like coffee: too little and you have no energy; too much and you get irritable. Since I live inside my own body, I always know when my dose is too low or too high. But in order to get the dose changed, I have to go and have a test. That test has backed up my own intuitions 100% of the time. It’s expensive and unnecessary. I put up with it because it’s free at McKinley, but I’d be much less willing to go through the legitimate routes if I was paying per visit to do so.
I think a McKinley-type subscription based service should certainly be available to people–just a matter of getting the costs right.
I also like the Planned Parenthood model, where everyone pays on a sliding scale to their income and they have a solid charitable fundraising arm.