Letter to the Editor for Oct. 21, 2013
Another possible solution to nation’s health care issue
Replacing Obamacare with a single-payer system of medicine as Gary Dielman advocates seems like a good idea. Medicine for profit will lead to abuse by the insurance companies — and by the MDs themselves, as they are after all human too. How many ineffective or damaging therapies and procedures have we seen phased out slowly so that we might not notice it? And we must wonder how many are still in place. I recently tried to get access to the OHSU medical library to try to clear up some medical matters and was told that I would need to be appointed to the medical faculty to receive online library privileges. This is a library system paid for with my tax dollars! Which brings up why a single-payer system wouldn’t work in our current top-down political system: collusion between the medical system and government, as well as the influence of drug companies.
In 1983 when I started working in hospitals, the government tried to introduce Diagnostic Related Groups (DRGs) a scheme to fix payments for any particular condition. If a hospital could direct treatment successfully for less, they would pocket the difference and standard reimbursements could then be whittled down. The doctors, administrators and insurance companies killed that one in a hurry! It would have been an example of how, with intelligent and responsible government oversight, medicine-for-profit could work. (There is also the matter of how under the present system, one can patent anything that works — including drugs — but not medical therapies.)
The solution I am proposing is a mixed one. The government would determine a reasonable payment for each diagnosis, subject to adjustment based upon details of the case. The patient would then be free to go to any provider that would accept that reimbursement (voucher) amount. The government would also offer an option of free medical service and hospitalization, manned by licensed personnel. Thus an open for-profit system and a socialized system would be in direct competition. The result, I am sure, would be a dramatic reduction in the overall cost of effective medical care.
R. Mack Augenfeld