Bureaucracy Is Our Friend
Governor Schwarzenegger, who was appearing in the national news only a month ago as the champion of Health Care Reform and universal mandatory health insurance, is now in the midst of yet another revenue shortfall. Wonks Anonymous would suggest that his relatives on the East Coast not worry too much, we have these things all the time in California. We live through them. Sort of like earthquakes.
Well the governor, who is on a friendly basis with health insurance executives, has decide to apply proven private sector principles to lower the costs of state sponsored medical care for the indigent, my people call it Medi-Cal. Rather than cut benefits or raise eligibility limits, which would appear ungenerous, he proposes a massive increase in the paperwork required to maintain eligibility. Medi-Cal beneficiaries will have to submit applications for the program four times a year.
Now most of us have never had to apply for welfare but many of us have have some experience of the type of application required here. Sort of a cross between your income tax form and the statement you fill out for your kids financial aid applications. Of course if you make a mistake you can be disqualified until you correct the mistake.
Most of us who have dealt with traditional health insurance know this one well. The more obscure paperwork you have to fill out to get payment on a claim, the less likely you will be to press the claim. The more complex the paperwork, the more likely you can be denied coverage on a technicality. Kudos to Arnold for bringing good old private sector (in)efficiency to bear on the solution of this important problem.
But this raises an question in Wonks Anonymous suspicious little mind. Universal mandatory health insurance, like the governor's plan, means that everyone has to buy health insurance or face fines and other penalties. This, we are told, is not really scary because the state will give subsidies to individuals and families who really cannot afford to pay for a policy.
I suppose that these subsidies will be administered in the same generous and uncomplicated way we now administer medical assistance to the indigent. I also expect that the funding for these subsidies will be constant regardless of the state of the economy.
Thanks for this post, "Bureaucracy Is Our Friend," and for the link to the article by Mr. Chorneau.
The mess in California stems in part from making the dollar bill more important than health care. It also stems in part from remaining blind to the fact that health care coverage does not mean health care. It means exposing people to all the business games engineered by health insurance companies designed to line their own pockets.
I noted in the article that Mr. Anthony Wright, executive director of Health Access, said, "This is a major step backward in terms of getting access to care for Californians."
To achieve clear and equal access to vital, comprehensive health care for everyone requires that this access become the bottom line in favor of the dollar bill. If access to dollars is the goal, then the dollar bill becomes the bottom line in favor of health care access. It seems clear what the California politicians want to achieve.
I do have one question about the last sentence of your post. Why do you expect that the funding for the subsidies would be constant regardless of the state of the economy?
R. Garth Kirkwood MD
http://www.equalhealthcareforall.com
doctork@equalhealthcareforall.com
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I have never seen any need based government program that was either uncomplicated or constantly funded. My reading of Charles Dickens novels - these are great fun and can teach us so much about our society - indicates that this has been true since the days of the English Poor law in the 18th and 19th century. I was too clever for my own good. Sorry.
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In the overhaul of our health care system that I propose, I want to stress the following: 1) Quality health care is a sound, ongoing doctor---patient relationship functioning for the purpose of properly dealing with any patient's medical problems in a setting absent embedded conflicts of interest. 2) The concept of "indigent people" does not exist because this implies indigent doctor---patient relationships and non-indigent doctor---patient relationships. This blatant economic discrimination needs to go away. 3)Health insurance companies function according to their own bottom line, the amount of dollars in profit at the end of the year, and they obstruct medical care for many people who cannot afford to contribute to that bottom line. And they really do not provide anything for health care, for the doctor---patient relationship, that cannot be provided by a clerk who simply functions to pay the bill. Therefore health insurance companies and their complicated roadblocks do not need to exist. These companies need to follow the concept of "indigent" out the door and not return. 4) Regarding the profit motive for the remainder of health care businesses, i.e., hospitals, drug companies, technology companies, out-patient facilities, doctors' practices, nursing homes, and many others, I do not wish to remove the profit motive. In fact, I want these businesses to make the necessary profit that enables them to continue to function superbly for the benefit of the doctor---patient relationship. 5)I do want to shift the profit motive, the dollar bill, from its position at the core of our health care system, i.e, as the centerpiece of our health care system. I want actual health care, sound, ongoing doctor---patient relationships, to become this centerpiece. This means that health care businesses recognize that their primary goal is the support of these doctor---patient relationships, i.e., the support of health care, and to accept that their profit motive, although important, is a distant second on their list of agendas to accomplish. A single payer is exactly what is needed to help our health care businesses accomplish this change in their thinking. And this can easily occur in a setting of earning substantial profit. However, it will require the removal of greed from the entire system. 6) In summary health care is NOT a business. It is sound, ongoing doctor---patient relationships for every patient in America being supported by businesses that need to make a good profit to function well. The bottom line then becomes the degree of penetration of these relationships into every American community.
R. Garth Kirkwood MD
http://www.equalhealthcareforall.com
doctork@equalhealthcareforall.com
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Amen to all of this. Pure profit motive, without professional or personal ethics, got us where we are.
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