why couldn't communities just open health clinics and hire MDs?

[grasswire]

Citizens could simply buy catastrophic insurance for major risks, and the clinics could do all the daily care. A community could even buy a hospital. Residents could buy in at a reasonable rate.

Eliminate the middleman. Eliminate the bureaucracy and the paperwork.

[texanwitch]

1. Sounds good to me.

The powers to be wouldn't let it happen.

Cut into their profit.

[truedelphi]

2. Actually during the fifties & early sixties, an entire network of community

Based hospitals came into being. All across the nation. And the buildings weren't just clinics - they were actual hospitals.

But slowly over the mid eighties to mid nineties, the community hospitals got put on the market and bought out through back room deals by unscrupulous Boards of Directors, and the hospitals came under the ownership of wonderful entities like Sucker. (Oops I mean Sutter!)

[Hannah Bell]

6. our community hospital got taken over by a "non-profit" hmo. who immediately

raised salaries for top execs & docs & went on a building spree.

services declined as well.

[KILL THE WISE ONE]

3. the northwest may be the easiest place to get this restarted

[Hannah Bell]

5. why the northwest?

[KILL THE WISE ONE]

46. there is a history of it here

[TreasonousBastard]

4. Money. It's not cheap setting up a properly equipped clinic...

and who is this "community" that is going to do it? And who defines just how much they can do there? Will they be able to set a bone, pop a carbuncle, stitch up a wound... Or will anything more than taking a blood sample require a trip to the local hospital...

Personally, I've been thinking for a while that local clinics should be more available, and more doctors should be on the payroll, rather than the group practices with pay-per-service that are the norm. I've heard of organizations, some gummint sponsored, that have been trying to do this, but I'm not familiar with all the details.

I believe I've heard Obama talk about clinics, but who knows what will end up in whatever we end up with.

[Hannah Bell]

7. create a hospital district by referendum & tax to maintain it. it used to be done routinely.

[TreasonousBastard]

9. "Tax" you say? In this environment? I would agree with you, but...

lately the dreaded T-word seems to kill just about any good idea out there.

We're talking about closing a very popular state park with a great beach down the road because The Empire State here can't come up with the $100,000 it would take to keep it open, and the town won't cough up a penny. Federal money? Hah! We've got a great Congressman who's found a lot of money for stuff like this, but he's been throwing up his hands for a while.

We do have a bunch of walk-in clinics that have popped up because so many doctors out here aren't taking new patients, especially Medicare patients. But, we also have two hospitals that aren't getting what they think is their fair share of local tax money and are constanly fundraising. And with tax complaints being a much bigger sport than golf around here, imagine the hilarity if anyone mentioned that taxes should be raised so we could build new public clinics.

[Hannah Bell]

11. balance that tax with the cost of health insurance, co-payments, & medicines.

if the hospital district negotiated group rates for meds & passed the savings along, it might work out quite nicely.

& if the hospital district tax covered all basic health & some critical care, & negotiated group rates with insurance corps for extraordinary care, it also might work out quite nicely.

$500/year/head in a region of 100,000 = $50 million.

Run family services with nurse-practitioners & PA's & run more intensive services with docs. Pay their malpractice for them at group rates. Offer them free housing.

Train nurses in-house through the local community college & offer them a tuition break if they commit to the equivalent in service time after graduation.

Just blue-skying here, but if there were the will to do it, practioners could figure out plenty of ways to cut costs without harming care -- and improving it, in many cases.

what does a family policy cost these days & how much out of pocket?

[TreasonousBastard]

32. I like your way of thinking, but I just don't see it happening...

there's no great public outcry for any of that. It may make a lot of sense, but inertia amongst both the public and the medical establishment is the most powerful force right now.

Look at the resistance to so much of what's already on the table-- the right wing and the teabaggers don't want any change and our side is quibbling over just what changes we'll accept. And look what all of this arguing has gotten us so far...

Now you want altruism and common sense?

[Hannah Bell]

43. what's currently on the table is looking like it will cost the average person *more*.

that's one reason there's resistance.

try something that will cost him less & give him more control & better care.

[grasswire]

35. it's nice to see you catch the vision

Families paying in excess of ten grand a year would surely be tempted to jettison the big insurers for a real local effort to maintain health under local control.

[Go2Peace]

8. Because the AMA fights against educating more doctors. We have an artificially low supply

Insurers are only one source of the problem. Greed is another. Noticed lately that Medical clinics are hiring more nurses but still charging Dr's prices even when you don't actually get Dr care?

All of these issues are fixable, but the primary issue is EVERYONE is greedy. Everyone wants to be rich, even if it causes all kinds of catastrophic problems throughout society.

[slipslidingaway]

12. Exactly...

what my daughter has said, there will be more physician assistants and nurses before you get to see a doctor.

Luckily for us she'll be a doc ... but not a hospital, lab etc.

Even with a portion of medical school paid, many students do not want to go into family practice...they still have to spend time arguing with insurance companies instead of practicing medicine.

And they are learning early on (within the first few weeks of third year) to order those extra tests in case they or the hospital are sued for missing something, although nobody thinks the tests are really necessary. Of course those are all RW talking points so best not to mention.

:shrug:

[Hannah Bell]

14. we have more docs per head than the UK, japan, or canada. for routine

matters, a nurse, NP or PA can do what a doc does at a lower cost. So long as there's good communication on patient care -- which, IMO, is one of the areas where US care falls short.

http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physicians-per-1-000-people.

[slipslidingaway]

16. I agree we could make more use of PA's, nurses at a lower cost...

interesting that other countries can do this with better outcomes.

Thanks for the link.

:)

[Hannah Bell]

17. in some of those countries with higher md/person ratios, the training received is sometimes

the equivalent of nursing or PA training, too.

go in for a stomachache, pa can deal with the 90% of cases with routine causes, pass on the ambiguous ones to MD.

Key is to follow-up well on the 90% to make sure one of the "routine" cases wasn't actually something else.

i have a friend who went in for nausea & was first diagnosed with kidney disease -- sent home to be followed-up in 3 months.

but she still had nausea & couldn't eat without throwing up. turned out to be a stomach tumor. but this was docs making the dx's. the confusion of multiple facilities, docs, & other professionals involved was a nightmare of overlapping jurisdictions & miscommunication.

imo, she got WORSE treatment than she would have from a single facility with good communication. i.e. the correct diagnosis would have been arrived at *much* sooner.

[Go2Peace]

20. We have more because we encourge them to leave their home country

with dreams of riches, and riches they can make here. Canada has a problem keeping DRs because many come here. Drs make good money in Canada but they can get rich in the US.

When I was young everyone understood that being a Dr meant patient before riches. It was expected. Something happened since then and now Drs offices are being seen as places to maximise profits. It's foolish to have a discussion of the problems with HC costs and yet ignore the outlandish rates Drs charge.

Of course there is lots of propaganda out there that they NEED to be that high. But that argument goes out the window when they hire nurses and still charge $250/hour. That's just plain bullshit driving costs up.

[Go2Peace]

21. Trouble is, they have to have a presiding DR, who charges full price for their services

and pockets the difference.

[Hannah Bell]

23. however, there is no rule that the presiding doc must charge doc prices for their services

& pocket the difference.

thus the value of a community funded medical system where such practices would be disallowed.

[Go2Peace]

25. I agree.

[old mark]

13. Got to keep those Doctors very rich, you know.....nt

[slipslidingaway]

15. You know it ain't cheap getting an MD degree ...

imagine have a quarter of a million debt and still having another 4+ years of residency.

:shrug:

And that is for an in state school.

[Go2Peace]

22. I have a friend who paid off his $150k debt in one year. Said it was "no big deal"

That medical school debt is relative. Paying off that kind of debt working at 50k a year takes eons. As a Dr, it is a much smaller component of business costs. Don't buy the excuses. For most Drs it's a drop in the bucket.

And really, there is no reason we can't offer to subsidize tuition to get more Drs and competition, except the AMA fights it tooth and nail. They want the price artificially high.

[slipslidingaway]

38. We'll see how long it takes and some of these students also have...

debt from college. Unless someone really wants to be a family doctor, I cannot blame them for looking at other specialties with a higher salary.

[TexasProgresive]

26. My niece is a doctor in Germany

She came out of med school without huge school loans to pay off- That's another thing we need to look at- tuition and health care have been running way ahead of inflation - why is that? I went to a private High School in the mid 60's the tuition is now 100 X what it was then. To make a comparison in auto prices a Buick would cost $500,000 if inflated at the same rate over the same time period. Go figure.

[slipslidingaway]

39. Yes tuition and heath care increases are making it harder for so many

people. We spent the holidays with some family and friends from the UK, we both have sons going to college next year. Tuition in the UK is 3000. and here we know we are looking at a minimum of $25000.

[old mark]

44. Here's a link for average "salaries" for internists in various areas of the US:

Link: http://mdsalaries.blogspot.com/2005/10/internist.html


Stop whining about how they suffer to pay their college bills - they can do it more easily than a nurse or a social worker can.

mark

[dkf]

42. How do they control this?

[canetoad]

10. It's a wonderful idea

and I wish there was a way it could work, but it would need a board of directors from the community and that's where it will fall flat. I'm not saying that there aren't a lot of great, compassionate and intelligent humans on community type boards, but in many cases the inept, greedy, power and glory seeking gravitate to these organisations.

Boards of community organisations almost without exception need to rely on a competent CEO to fill in the knowledge gaps that all the well-meaning in the world wont cover. I know - worked closely with many small, elected boards.

There are exceptions, but I think this is the general rule.

[Greyhound]

18. People alive today can remember when that was pretty much the norm.

One of the great overlooked obscenities of the 80's was the wholesale distribution of community (municipal) hospitals and health care centers to the for-profit industry, thus ensuring a captive market for their scheme. It's the same plan the corporations used in the 50's to destroy public transportation.

They simply cannot compete with community based anything simply because of the built-in costs of corporate bureaucracy, shareholder dividends, and executive salaries. It's just arithmetic, but The Big Lie campaign has worked wonders, convincing the unthinking that "corporate efficiency" is not only possible, but that it exists IRL.

[Hannah Bell]

24. "ensuring a captive market" - "same plan the corporations used in the 50's"

i never thought of it like that, but that's exactly right.

[cali]

19. This is why Bernie put the 10 billion in the Senate bill

Vermont, btw, has 6 CHCs that provide extensive health care services from dental to mental health. 20% of the state gets their healthcare through these CHCs.

[mucifer]

27. The government did put some money into 120 new health clinics nationwide

It's a start.
http://www.whitehouse.gov/the-press-office/president-obama-nominates-governor-kathleen-sebelius-secretary-hhs-announces-releas


President Obama today also announced the release of $155 million authorized by the American Recovery and Reinvestment Act that will support 126 new health centers. These health centers will help people in need – many with no health insurance – obtain access to comprehensive primary and preventive health care services.
"We have acted quickly to put Recovery Act dollars to good use in communities across America," said President Obama. "The construction and expansion of health centers will create thousands of new jobs, help provide health care to an estimated 750,000 Americans across the country who wouldn’t have access to care without these centers, and take another step toward an affordable, accessible health care system."
The grants, which are administered by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA), are expected to create 5,500 jobs at the new health centers.


a bit of a drop in the bucket. But, Obama did do this.

[Vinca]

28. Communities are, by and large, broke.

With schools going to 4 day weeks to save money, it's highly unlikely health centers would even be considered unless there was a huge rather than symbolic effort from Washington. Bernie Sanders is on the right track, but there are too few Bernies around.

[lazer47]

29. Haven't you heard,,When communities ban together for social purposes

That is called Socialism,, by the repugs,, we just can't have that kind of thinking going on..

[stray cat]

30. Clinics still require money to operate - staff expect to be paid and treatments cost money

[sinkingfeeling]

31. I doubt if we can recreate the 1940's and 50's. There were city and county hospitals everywhere.

[grasswire]

33. If people could see the numbers, they'd be clamoring for it.

Families paying as much for insurance (or more) than for their housing, people enduring the denials and runarounds of insurers -- if they could see the practicality of joining with others in their own community to find space and hire doctors and nurses..............I think even conservatives are smart enough to want that for themselves.

As Hannah Bell says, $500 from 100,000 people is $50 million. There's empty space in every city -- the property downer could donate and get a tax credit.

Huge savings would come by eliminating the bureaucracy. Simple fee for service.

Just because it's complicated doesn't mean it can't be done.

I am beginning to believe that TPTB are engaging in a more fiendish kind of disaster capitalism -- allowing many many people to die so as to "cull the herd" of those who are too expensive. That would mean retirees, sick, and disabled. Those who receive "entitlements." Why would they not engage in this?

[Lucy Goosey]

34. That's how the push for universal coverage started in Canada.

Be careful! It's a slippery slope to Communism!

In the early-mid 20th century, Saskatchewan was experiencing doctor shortages, and municipalities started subsidising doctors who were willing to stay and practice locally. Groups of communities also started banding together to create and subsidise hospitals.

Seeing the success of these, Premier Tommy Douglas's government passed the Saskatchewan Hospital Act in 1946, which guaranteed free access to hospital care for all residents of Saskatchewan.

Other provinces followed, and by 1958, the federal government was helping fund these provincial programs. In 1966, the Medical Care Act established the national Medicare system.

And as we all know, Canada subsequently joined the Soviet Union and became a wretched festering hell-hole; an oppressed shadow of its former self. :eyes: Beware!

[grasswire]

36. heck, there was a major TV sitcom with that theme

About the community in Alaska ---- the name is escaping me. The community hired the doctor.

[Lucy Goosey]

37. Northern Exposure.

The community had also paid for his med school.

[Johonny]

40. why don't communities take those empty factories

hire workers and make things in the US? It's amazing what communities will spend money on and what they are very reluctant to spend money on.

[grasswire]

41. apparently they like to dump dollars in the toilet

cuz that's what's happening with a lot of the health care $$.

Get off the treadmill, people. It doesn't have to be this way!

[nemo137]

45. I'm not sure TWE you've been paying attention to local politics these past few years

but "communites" (state, county, township, city, etc) are not exactly flush with cash for embarking on big new projects.