It seems that all the discussion about health care in the US focuses on government policy, insurance companies, and drug and medical device manufacturers. I guess that is because those are the entities that get most of the money. But, in the final analysis, good health care for people with medical problems depends on the willing service of well-trained doctors, and it is such persons who will sometimes have to battle the bureaucracies in place to fulfill their callings.
Mr. Mac Bennett, president and CEO of United Way of the Midlands (Yes, even for the United Way, the president and CEO jobs should be separated.) wrote an editorial for The State about servant physician Dr. Stuart Hamilton who, thirty years ago, established the Eau Clair Cooperative Health Centers (ECCHC) in Columbia, SC. According to their website, ECCHC’s mission is to “provide comprehensive, high quality compassionate medical care in the spirit of the Good Samaritan,” and it does so for low-income, medically underserved, and uninsured patients using income based fees for those in financial distress. The centers accept Medicaid, Medicare, and donations from “individuals, churches, civic groups, corporations, and foundations.”
ECCHC is not a small, underfunded, operation. There are about fifteen sites, including a pharmacy and a dental practice, and areas of expertise include pediatrics, OB/GYN, counseling and behavioral medicine, internal medicine, and family practice. Current staff includes about 30 MD’s. Approximately 40,000 low income patients are served. According to Mr. Bennett’s column, United Way funds a program called The Plan which gives uninsured patients unlimited primary care doctor visits and discounts on other services for a payment of $25 per month.
My suggestion is that the best way to achieve access to health care for all is not through government mandates and expanded public and private bureaucracies employing hundreds of thousands of people unqualified to provide health care but through enabling physicians such as Dr. Hamilton, a true hero, and those who are employed by his organization to do their thing as simply as possible. What joy he and his employees must get from the good that has been done over the past three decades!
Here are links to Mr. Bennett's column and to the Eau Clair Cooperative website. There is a nice picture of Dr. Hamilton at the website.
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Tuesday, November 15, 2011
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Most health care economists with a world view acknowledge that our many bureaucracies drive our excessive costs for health care in America. Controlling health care costs in America is an operational definition of a conundrum. Thinking small with a system of accountability for a fee for service system drives the costs way up employing many non-medical people and consuming much nurse and physician time. I feel most comfortable with having and paying for a primary care physician managing my care directly and indirectly by nurses and a minimum of other support staff. I would feel fine about seeing a specialist only when my primary care physician recognizes that he or she needs specialist advice or procedures done. In the US there are some instances of managed care, but by operating in a business climate of fee for service many of the bureaucratic costs remain so there is only the savings of patients not seeing specialists quite as often. The largest example in the US is the VA. It costs much less, the quality is good most of the time. It comes at a great cost savings despite the cost of the accounting that resembles fee for service.
ReplyDeleteThe "Permanent Fix" is to transform/morph our high quality fee for service system into a high quality managed care system. Otherwise, we will be playing around the edges of cost containment and having real problems of providing good consistent health care for all Americans with a more reasonable expense. Too many Americans are not willing to pay for health care for all citizens with our expensive system of Medicare, Medicaid, and private insurance. Biggest part of the solution is to reduce to change the system; the other part is to maintain a critical mass/majority of power to commit to paying the bill and making the unwilling pay. "Obamma Care" only touched on the system changes and put the second into place. The second part of solution is loosing ground. Obamma's stated preference for a single payer government system would have moved toward a system with more hope for cost containment, but at the end of the day the health insurance companies brokered a fix that protected their turf and allowed health care access to be expanded. Obamma's pragmatic bent allowed this in order to achieve the stated goal to improve health care access for those on the margins. If the US Supreme Court rejects "Obamma Care", we will be back to the drawing board. As a progressive, I do have some sympathies for my conservative friends' objections to compulsory private health care insurance. The next time around I hope that both issues of the system and paying for health care are addressed to provide health care access for all Americans.