We need a public option with a French accent

I’ve been thinking a lot lately about the inefficiencies in the US health insurance system, as compared with what seems to be the amazingly efficient French system. Most talk is centered on inequity here, which is the bottom line, of course. Still, we like to believe that the economy (and all progress in this country) is driven by efficiency, innovation, and productivity, so the contrast in this case seems rather alarming.

Listen here to author T.R. Reid on his experiences in doctor’s offices around the globe, seeking help for a “bum shoulder”. Listen, particularly, to his account of the French system of files and payment processing.

[In France and other ‘Bismarck model” European countries] These are private docs, private hospitals, and mainly private insurance plans…

This business in America where we have the in-network deal or we have to get pre-authorization; any doctor, any clinic, anybody in the entire country, you chose ‘em, you go, and insurance has to pay the bill within two weeks or so…

[French doctor’s offices] are Spartan... What’s missing [...] is the files and files of patient records, and there’s no billing office… the patient comes in, out of her pocket she pulls […] the Card Vitale, he puts it in a reader on his desk and her entire medical record shows up on the screen. He chats with her about her problem, he’s typing down what she’s got wrong, and he says “I’m going to prescribe a course of antibiotic” […] and he’s typing all that up. He’s finished with her, […] he hits one key on his computer and the entire bill has gone to her insurance company, he’s going to be paid in three days, and she’s gonna get her copay back from the insurance company within two weeks. Done. No paperwork.

Compare that to the situation now facing my sister, trying to get her daughter needed treatment for a deforming case of scoliosis. The condition is not, of itself, life threatening, but further deformation could begin to impact internal organs, including her lungs. The girl has, since birth, been very susceptible to lung ailments.

The treatment is thoracic spinal fusion, a 7-8 hour surgery that, while not uncommon, is far from routine. My sister’s search up and down California for a doctor competent to perform the surgery who would also accept Medicaid led to UCLA, where the surgery is performed, apparently, hundreds of times per year.

My sister lives in Northern California, so the team at UCLA worked with her doctor up north to coordinate some of the pre-op work and insurance submittals. There were two necessary pre-op trips to LA. The surgery was scheduled for today, September 15. The family flew down this weekend, mom, dad, the patient, and her twin sister. Dad and sis planned to go home Friday, while the patient would not be clear to travel for three weeks, so she and mom would stay down here.

What do you say to a kid about to go under the knife? I told her it would all be over in two days, and she wouldn’t have to think about it anymore.

So I was sickened yesterday when I heard that the surgery had been postponed for at least three weeks, because her Medicaid paperwork had been lost in some shuffle or another and UCLA won’t do the surgery until it is pre-authorized. In the meanwhile, her parents must find money to change tickets and buy new ones, putting more financial stress on an already stressed family.

“Medicaid is a government program!” I can already hear the screeches. But this situation isn’t unique to public insurance. It’s due to an approval system in use by public and private insurers, and it’s stupid, and it’s wrong, and it wastes time and money.

There is (or there was a couple of weeks ago) language in the current house bill that would enable electronic funds transfers between doctors and Medicare/Medicaid, and presumably other public insurers. That’s a good step.

Now how about language that removes pre-approval from the transaction? The doctor treats, the doctor gets paid. If there is reasonable suspicion of fraud after the fact, it becomes a criminal investigation. If the fraud were committed against a public plan, the charges would be federal, and the penalties would be stiff, and would include prison time.

I’d like it if we followed the Swiss model, and made for-profit basic health insurance illegal. If we can’t do that yet, we should build a strong new public option, while strengthening Medicare and Medicaid. These programs should have zero pre-authorization requirements, and be dedicated to innovating payment and record keeping systems.

If the private sector won’t do it, the government must. And if the private sector wants to remain competitive, it’ll have to go along.

(Here's the NYT story on Reid's book.)

Thanks a lot, asshole

At the gas station this morning, and this story came over my local NPR station.

One person injured during altercation at healthcare rally in T.O.

TPM's already got a link up, so the story isn't staying local. There are, as well, conflicting eye-witness accounts of the incident, who did what, the usual. The basic facts are not disputed, though: an anti-reformer and a pro-reformer mixed it up, and the anti-reformer got his finger bitten off at the first knuckle.

Depressing that a pro-reform demonstrator committed assault? Oh, absolutely. Here we've been asserting all summer that we just want a discussion based on fact, that we're trying to be rational and democratic (please note the small d), while the opposition is intent on pushing crazy paranoid junk and intimidation. And someone here in my little town just lost it and irresponsibly engaged in confrontation, and committed assault.

Dude, whoever you are: that's MY corner you just shit on, and I don't really care who started it.

That's the corner where we demonstrated every weekend from November 2002 through March 2003 against war with Iraq, the corner we've returned to many times since, to rally or to mourn. That's the corner where we stood silently while people yelled obscenities at us, that's the corner where we stood in pouring rain while Catholic schoolgirls engaged in counter-demonstration across the street.

That's the corner where I stood smiling, eyes full of tears, as teenagers gleefully and proudly joined our ranks in support of marriage equality and against discrimination in all its forms.

That's the corner where we have peacefully gathered and sometimes cried and always been respectful, reminding our neighbors that here in Reagan country, there is a liberal population.

And that's the corner where I have personally engaged in some amazing conversations, like the time a young Army recruit came to ask me to explain if we could support the troops and oppose the war. The Catholic schoolgirls I mentioned above, who were really very brave, out there in the rain, and we talked about Catholic beliefs (Pope John Paul, remember, spoke out against the invasion of Iraq), and how they could support the invasion if they understood that civilians would die.

I wasn't there last night. I haven't been there for a demonstration since shortly after prop 8 passed. I don't respond to the MoveOn organizing emails lately, because there are several people here in the Conejo who are well-connected and can be relied upon to answer the call (in fact, often several people put up the same event). They're very good at this, so I'm not much needed, really.

One thing you can generally count on at larger demonstrations is that there will be a group charged with being peacemakers. Often, their jobs will be to just keep the two sides physically apart. At the 2004 March for Women's Lives in DC, attendees were asked to come to peacekeeper training the night before. During the March, peacekeepers often formed human chains, arms linked, keeping the marchers separated from the anti-abortion protesters who staged a "die-in" at the front of the march (they were removed by law enforcement), and stationed in clumps along the way. At Camp Casey in the summer of 2005, a firm no-man's-land was monitored by both the local police (who were wonderful, and friends of the Camp) and designated campers. In both cases, in addition to the peacekeepers, all attendees were admonished at the start to refrain from engaging the other side in anger.

In TO, the corner has always been so small, 35 to 150 people, and always familiar faces. Organized peacekeeping hasn't been necessary. Individuals reminding each other to behave is really all it's ever taken. There has been no hard fast rule about crossing the street, because people who cross the street do so to shake hands and agree that we all have good intentions. 

(Ok, there was the one time I lost it on a neo-Nazi, but I'm only human and anyway once I realized I was screaming I forced myself to walk away.)

So it would seem that the conversation in this country has become so heated that even here, in little TO, the civility of the population cannot be taken for granted anymore. I'm sickened that our corner was disgraced last night. I'm wondering if I feel a responsibility to be there from now on, or if I'm having grandiose notions of just how much help am.

I have no wise conclusions as of this morning. I'm just sad, and angry too.

Incidentally, it's interesting, in a vaguely nauseating way, that the intensity of emotion over health care reform trumps the public concern over the invasion of Iraq.