In reality I am traveling the world via my computer. I research for days before I post a World Traveler report. This report has actually been years in the making. Years of research and years of making phone calls. I have been really amazed at the number of people in foreign countries that speak English at some level. Most of them are actually quite good at it. Of course about half of the world was once under the control of Great Britain so I guess this should not surprise me much. However, these countries have long been independent from British control and yet the English there is as good as most of the teenagers I know here in the US. They also speak texting so OMG means the same to them as it means to my teen. If all else fails and the person on the end of the line does not understand me I will resort to speaking texting and I can usually get an English speaking person on the phone pretty quickly.
I decided that I would take a look at some of the healthcare models out there right now. However before I do that I wanted to share a paragraph from a Washington Post article by T.R. Reid posted on 23 August 2009 entitled "5 Myths About Healthcare Around the World." T.R. Reid states:
In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.
Now to be fair this author did not actually cover how we handle healthcare for the poor who are raising children. I could be wrong here but I have decided that the reason the author did not touch medicaid is because it is such a nightmare that even the author was confused about who created this nightmare and what model they used to create it. Medicaid is a nightmare because it is not universal across the states. Right off the bat I will attest to the fact that people in NC have better services than the people of Alabama get through Medicaid but much of that has to do with the availability of services within the state. However, there is still a great deal of the problem resting in the fact that the state manages what is and is not covered by the medicaid funds provided by the federal government.
Assuming that I am right about why the author chose not to talk about medicaid in the article then the author and I have something in common because I too am bamboozled at who or what this method was modeled after. Therefore, like the author I too am going to steer clear of this nightmare for right now. I promise you all that I will do a little more research on Medicaid and spend an entire post just on it. Maybe even a series on it if I find enough information to create clarity or totally boggle the mind about the stupidity of the model. Meanwhile lets look at the rest of healthcare in this country based on the author's description of how we handle the care.
Veterans Hospitals and Tribal Medical Facilities
"For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills."
Ok, so we give the men who go to war for our country universal healthcare that is paid for through our taxes. Now this is the same type of healthcare that we constantly hear denounced and not good enough for the general population of the USA. Bureaucrats on death panels will decide out medical care if we go to a government run system. Or we are slipping into a socialist agenda in the country.
Now I don't know about you but I would think that a country that likes to go to war as much as we do and who promotes the value of our men and women in uniform would afford them the highest quality healthcare available. Somehow, I must have lost a page in the playbook here where they go from being our heroes to be the scum of the earth that we throw into a medical system that we would not wish on our dogs let alone on ourselves. If you have a copy of that missing page in your playbook of Life In America then please scan and e-mail it to me because I am dying to know what the veterans did that moved them from hero to zero so that we are willing to toss them into this "bad ole socialized medicine" model of medical care.
The other group that we are willing to sacrifice to "socialized medicine" actually has a model close to what medicaid uses. The money is federal but managed by the tribe. However the tribal council has to live with the rest of the tribe so they do a much better job of managing the money. Now I am once again confused here. If we think socialized medicine is bad then why do we force it on the group of people that we are indebted to for the entirety of this country. However, if it is so great then why do they get it and the rest of us don't.
So let me get this picture clear in my mind; on one hand we have people saying that socialized medicine is bad while on the other hand we are providing it to the former soldiers who have given their service to our ideals of democracy and we are giving it to a people from whom we stole this land. However the rest of the citizens of this country are too good or not good enough for this same benefit.
Makes perfect sense to me. NOT!
The Worker
"For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals."
Well Isn't That Special! However partially inaccurate.
The average American worker does not actually get a useful insurance plan and the majority of the companies out there do not contribute one red cent to their worker's insurance. Companies like Wal-Mart, Wendy's, and Kroger. If you want insurance and you are not management then you can buy it for a pretty decent amount of money but the group rates are because a few labor unions in a group of states where they rule the roost have bargained with insurance companies to provide workers in their similar trades the opportunity to buy into healthcare plans as part of a collective group in states where those very same unions barely have members because the laws of the states protect the businesses from labor unions.
To be fair I have to admit that most white collar jobs do provide healthcare to their employees at little to no cost for the employee and reduced cost for the employee's family. They also do something that creates part of the problem when we try to discuss a socialized medicine or single payer system with white collar workers, they take the money directly out of their checks before the employee gets their pay. Employees rarely if ever can tell me exactly how much they currently spend on healthcare because they are used to getting that check and the healthcare is already taken care of and they learn to live on the budget after the healthcare payment is made. They can tell me how much their co-pay is and how much they spend on their prescription drugs. However, if I press them to tell me how much their premium is for their health insurance 90% or more will not be able to accurately relate that number to me.
How do you discuss the cost of a universal healthcare system with people that have no idea how much they pay for what they already have? I have no answer for that simply because I am not one of those people and never have been. I have to know. I have to understand what I am buying and if it is worth my money. I do know that until we get them to wake up to what they are paying and what they are getting we will never convince them that there is a better way.
The Elderly
"For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule."
Well now this really bites the big one doesn't it. A huge number of the elderly are the very ones that are screaming that we are sliding into socialism when we want what they have that we are helping to pay for. I actually understand their fears. They were part of the cold war generation coming after World War Two. Their fears make sense because they see Russian spies at every turn infiltrating our government. My parents are part of this generation and by the grace of my heavenly father I still have one of them with me, the saner one. My father, rest his soul, was a conspiracy theorist, anti-government, anti-communist, libertarian anarchist who trusted the government as far as he could throw it. I am pretty sure he is going to be upset with all of us because we did not bury any of his guns with him or his MREs.
My dad used to tell me that shoes were a Russian plot against our nation because when they decided to come over here and take over they were going to take all our shoes away from us so we could not chase them down and kill them all. So he taught me to shoot before I turned 12 and I never wore shoes unless I had to go into a building that made me or it was too cold to go without them according to my saner parent. Of course coats were a communist plot against our nation too but I am not going into his logic on that one ever!
My dad was a bit over the top but after listening to several of his friends talk at his funeral I have decided that he was not alone in his concerns that we have life far too good over here and that communism/socialism is not going to take over our country through nuclear war but through infiltration. The cold war is not over to them. The cold war was never about nukes to them. It was always about the ideal democracy versus the ideal society. It was always about the fact that most of his friends barely graduated high school and yet managed to make it in the world to the point that they had six figure incomes prior to 1990.
You see my dad actually lived the American Dream. He was a high school drop out with a GED that he got while in the military. He served in the Army and the Coast Guard. Remember that little difficulty we had with Cuba over some toys they had borrowed from Russia? Well my dad was sitting on a Coast Guard Cutter monitoring that entire escapade. It was his Cutter that first noticed a CHAYKA signal coming from Cuba where there had not been one before. He was coming on duty to monitor the LORAN station on the cutter when the person that he was to relieve picked up the first CHAYKA signal. This led to the reconnaissance flights over Cuba which found the build-up of Soviet missiles. You see there should have been no reason for the navigational signal to be where it was because that area was not a major port. It was there to help the Russian vessels avoid detection by the ever vigilant US Coast Guard while they slipped missiles into Cuba.
After his service in the military and due to his extensive knowledge of the electronics of the time he was eligible to be tested by IBM and he got hired. This was in the 1960s and by 1983 he had left them and followed former IBMer George Amdahl into what would be the only real competition that IBM would ever see, Amdahl Corporation. In 1983 my dad lived in the silicon valley in sunny Cupertino, CA and had a gross income of just over $105,000 per year. He had the bull by the horns and was winning the war. He was the image of what the American Dream was all about. When he died in 2003 his annual income was not even as much as my mom made which was upwards of $72,000 per year. When she retired her first Social Security benefits were on her $71,873 annual salary and his Social Security was higher so she drew off of his. At the next review another quarter had passed and her Social Security would be paid based on her final salary which was $72,439 per year. This means that somewhere along the way as expenses and the cost of living climbed, my dad's income went down. He changed jobs when Amdahl Corporation was bought out by a Japanese company and when he did he took a horrible pay cut. The American Dream was dead to him.
Where do we go from here?
From here we have to decide if we are going to continue to have this crazy quilt model of healthcare or whether we are going to move beyond the cold war fears of universal social programs being a sure sign that we are headed down a road to being a communistic/socialistic country. We really have to step beyond this fear of the communist plots and seeing Soviet or Chinese spies behind every tree. Now we cannot push those fears onto Muslims either because every Muslim is not a radical jihadist. If we are insistent on a quilt model because we have to make everything we do uniquely American then we need to examine the various models and take pieces of each one and make one large well designed patchwork quilt to cover all of America.
To accomplish that task, We first have to step back and take a long look at a country that has surpassed us in education, healthcare, and economic strength. We have to look at how they did it and reach for a working model. Admittedly, they have not done everything perfectly. They have had incidents happen that have made them have to stop and re-evaluate their methodologies. However, over all they have accomplished a miraculous recovery from a state of utter devastation unlike anything America has ever experienced and surpassed us in advances in technology development to the point that I challenge any one out there to show me a home that does not contain at least one item developed, designed, or manufactured in this country. What country? JAPAN.
To be perfectly honest Japan's healthcare system is not the pristine model that I would hold up and say that we need to copy it totally. They totally underestimated the number of people that they would need to treat and so there were incidents of deaths that occurred due to the failure to have beds available to treat patients. There are horror stories of patients being turned away from as many as 14 to 15 hospitals due to lack of space and dying from conditions that would have been treatable if they had been admitted at the first or even the second hospital. Hospitals are still the primary source of medical treatment instead of private practice or even public sector physicians. However, there are aspects of the Japanese system that are useable for us and that is what I will explore here.
Japan has a system that is disjointed to a certain degree. Part of their system is based in the employed arena and the other part is based in the unemployed arena, If you have a job your payments go into a system that only has employed people in it. If you are unemployed you are covered by a tax funded system. The employed system has numerous groupings in it based on the type of job a person has.This all seemed a little clunky to me but upon further exploration I found that the Japanese think it is a little clunky too. They are in the process of streamlining this system and the changes they have already decided upon are not yet fully implemented. This unfortunately leaves me only the old system to evaluate at this point in time.
What do we need to take from the Japanese system?
We need to take three things from the Japanese system that are absolutely crucial to us being a World Leader in how we manage the healthcare of our citizens.
Those three things are:
1. All the elderly must be fully covered for all their medical needs regardless of how many of them there are at any point in time.
2. All premiums, fees, co-pays, or any other financial outlay by the family must be on a sliding scale based on income of the family.
3. We need to fully fund alternative medicine and wellness programs including traditional Chinese, Japanese, and Native American medicines as well as nutritional programs and programs that treat stress through relaxation techniques including spa and therapeutic massage treatments.
What can we take from other countries that they do right?
Canada:
Portability:
Canada's system is a Provincial Insurance Program running under federal mandates. It is jointly funded by the federal Canadian government and the provincial governments. Their portability program makes sure the new province has time to prepare for the potential expenses of the new arrival by having the old province continue coverage of the person until the waiting period for the new province kicks in. The maximum wait time is 3 months for any province.
Public/Private Mixture: Canada currently has a system where there are private "for profit" clinics and private insurance available. By law these clinics are not supposed to provide any services covered by the Canadian healthcare system. Private insurances cover anything not covered by the public healthcare system. I believe we need to look at the viability of having a more intense mixed model and how that might work for the USA.
United Kingdom:
The United Kingdom actually consists of four separate National Healthcare Services for each of the four countries England, Wales, Scotland, and Northern Ireland. Immediately after WWII the NHS was established as a centrally controlled entity. Eventually, over time it was devolved into four separate entities. However, each entity treats any UK citizen. SO if I am a resident of London who is visiting Scotland and I get sick my medical care is covered in Scotland.
In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. These guidelines are established by panels of medical experts who specialize in the area being reviewed.
Cost control in the UK is handled as describe here:
In Scotland, the Scottish Medicines Consortium advises NHS Boards there about all newly licensed medicines and formulations of existing medicines as well as the use of antimicrobiotics but does not assess vaccines, branded generics, non-prescription-only medicines (POMs), blood products and substitutes or diagnostic drugs. Some new drugs are available for prescription more quickly than in the rest of the UK. At times this has led to complaints.
This is one of the fear-mongers favorite things to bring to the attention of those who fear socialization of medicine. What most people fail to realize is that this exact same method is used by private insurance companies to decide what they will and will not cover. The difference in the two is that the government agencies are considering the cost burden for the total population to fund these treatments versus the actual outcomes and the insurance company is considering the bonuses that can be paid to the employees of the company like the CEO and the Claims Specialists if coverage is refused and the company makes more money. Personally if I have to die because someone refuses to pay for an experimental treatment that might or might not save my life I would prefer it to be because they did not want to unduly burden my next door neighbor with more taxes rather than to buy a CEO of my insurance company a new Yacht.
One thing to remember regarding the devolved UK system is that it is managed by each country and they have different approaches to their national healthcare system. An example that comes to mind is the fact that while England is allowing more private sector involvement with their NHS, Scotland is doing everything it can to move in the totally opposite direction toward a position where there will be no private involvement in their NHS. This might even be a workable solution so long as the mandates are set nationally about what is and is not covered by the Centralized healthcare.
Dental Services:
Each NHS system within the United kingdom provides dental services through private dental practises and dentists can only charge NHS patients at the set rates for each country. Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists in England comes from work sub-contracted from the NHS, however not all dentists choose to do NHS work.
Please note that there are no restrictions to only dental surgeries or such nonsense. They realize that if a person cannot chew their food that they are more likely to have stomach and other digestive problems so they treat the teeth as part of the body to be cared for.
Medications:
All medications have a single price. It does not matter if your doctor gives you 10 pills or 60 pills you pay a single price for all medications. The cost is about $10US and people over 59 and under 16 are free. This applies only to England. Wales, Scotland, and Northern Ireland have no prescription drug cost.
The next country I want to look at is the one that the WHO lists as the best in the world for healthcare. So America pull up a chair and break out your freedom fries while we go take a long look at how France does what they do. Most of my information comes from the Wikipedia site for the French healthcare System with verification from friends and several government agencies regarding the accuracy of what is in the article. The parts that I have chosen to include here have been personally verified by me through one of my sources. I will not provide a link to the entire article, because I cannot guarantee that other facts contained in the article are accurate. Let me state one thing that is running around and is semi-fact and semi-fiction with regard to a certain government program for new mothers. The only way the French government workers that come in after a child is born to help the new mother can actually do laundry for the family is if there is a problem of neglect by the mother due to things like postpartum depression or the inability to care for the child due to complications of the pregnancy. The government workers are not maids but are there to guarantee the well being of the family and to support the mother in her new role as a caretaker of a child. This is even done for mothers who already have children in order to be sure the older child is coping well with the new addition to the family with little to no typical jealousies being expressed by dangerous behaviors. They have the ounce of prevention is worth a pound of cure mentality and they also have the lowest infant mortality rate in the world as well as the fewest cases of child abuse and neglect.
span style="font-weight:bold;">France:
Solidarity: An important element of the French insurance system is solidarity: the more ill a person becomes, the less they pay. This means that for people with serious or chronic illnesses, the insurance system reimburses them 100 % of expenses and waives their co-payment charges.
Government Responsibility:
The government has two responsibilities in this system:
The first is a government responsibility that fixes the rate at which medical expenses should be negotiated and it does this in two ways. The Ministry of Health directly negotiates prices of medicine with the manufacturers, based on the average price of sale observed in neighboring countries. A board of doctors and experts decides if the medicine provides a valuable enough medical benefit to be reimbursed (note that most medicine is reimbursed, including homeopathy). In parallel, the government fixes the reimbursement rate for medical services.... These tariffs are set annually through negotiation with doctors' representative organizations.
The second government responsibility is oversight of health-insurance funds, to ensure that they are correctly managing the sums they receive, and to ensure oversight of the public hospital network.
One thing that I removed from the previous quote that I disagree with is the right of doctors to charge whatever rate they want to charge. The reason I disagree with it in context to the French system is that the French system requires the individual to pay and reimburses the individual assuming they have a job and can afford the funds. Since they charge the person up front if they charge more than the government agreed price then the individual gets stuck with the difference. This is not a good scenario in my opinion. My one complaint about the French system is the pay and get reimbursed model. Of course this does not limit access to healthcare in any way since they are all seen and billed later for the treatments they receive.
Investment Income:
Another thing that is great about the system is the fact that people who make all or most of their money from investment income pay into the system also which reduces the amount that the workers have to pay. This is done in a way that includes other forms of income also. This is a recent change and this is how it is explained in Wikipedia:
Because the model of finance in the French health care system is based on a social insurance model, contributions to the scheme are based on income. Prior to reform of the system in 1998, contributions were 12.8% of gross earnings levied on the employer and 6.8% levied directly on the employee. The 1998 reforms extended the system so that the more wealthy with capital income (and not just those with income from employment) also had to contribute; since then the 6.8% figure has dropped to 0.75% of earned income. In its place a wider levy based on total income has been introduced, gambling taxes are now redirected towards health care and recipients of social benefits also must contribute. Because the insurance is compulsory, the system is effectively financed by general taxation rather than traditional insurance (as typified by auto or home insurance, where risk levels determine premiums).
Gatekeepers: The system is highly dependent on Gatekeeper General Practitioner Physicians. These doctors decide if a patient need to see a specialist or be hospitalized.
The médecin généraliste (commonly called docteur) is responsible for patient long-term care. This implies prevention, education, care of diseases and traumas that do not require a specialist. They also follow severe diseases day-to-day (between acute crises that may require a specialist).
They survey epidemics, fulfill a legal role (consultation of traumas that can bring compensation, certificates for the practice of a sport, death certificates, certificates for hospitalization without consent in case of mental incapacity), and a role in emergency care (they can be called by the samu, the emergency medical service). They often go to a patient's home if the patient cannot come to the consulting room (especially in case of children or old people) and they must also perform night and week-end duty.
SAMU:
The other ting we need to take from France is not really about how they finance medical care as much of my focus has been on up to this point but about how they actually deliver care, specifically how they deliver Urgent or Emergency care. France has, in my opinion, the best Urgent/Emergency care response ideas in the world. The greatest cost in Urgent/Emergency care are the operation of buildings. This is also the one time when getting to those building is the hardest.
Have you ever had the flu and just finally gotten to the point that you realize that you are not winning the war but you really do not feel like getting up and going to a doctor or the hospital? Well in France you would not have to because the doctor would come to courtesy of SAMU. This is wonderful because if I am going to my doctor for my annual checkup I would really prefer not to sit in the waiting room with someone with the flu. By that same token if I have the flu I should want to keep myself isolated from even my family members as much as possible in order to prevent them from getting it. Riding in a closed up car with them to the doctor's office is not how you accomplish that goal.
In France if you are ill you can call SAMU and explain the illness to them and they will dispatch the appropriate type of medical care directly to you. It is far more cost effective to send the doctors to the patients in many cases of extreme and particularly contagious illnesses that to bring the patient to the doctor and risk infecting others. SAMU also covers trauma patients and one of the options available is literally a mobile intensive care unit MICU for those who might have need of such extreme levels of care. The MICU units have a specially trained doctor on board who is prepared to handle most anything that a normal Intensive Care Hospital Unit can handle. The MICU units are solely for the purpose of rapidly stabilizing the patient and to transport the patient to a hospital Intensive Care Unit. The advantage is the rapid application of ICU protocols often improve the chances of the patient to recover from their illness.
Now I do not want to give you the impression that if you have a common cold that you can call SAMU ans they will send a doctor to you. That is not reality. reality is that only about 65% of all incoming calls get an ambulance response. The calls are triaged by medical staff based in a hospital. These people will do everything in their power to avoid sending an ambulance to you if there is another option. However, if there is not another option within 10 minutes of the end of the call you will have someone knocking on your door to take care of you.
Wikipedia fully describes the role of SAMU liek this:
SAMU missions were defined in a law of 1986 as hospital based services providing permanent phone support, choosing and dispatching the proper response for a phone call request. The central component of SAMU is the dispatch centre where a medical regulation team of physicians and assistants has the task of:
analysing calls to decide on patient need
deciding the best solution for the patient's care
dispatching the most appropriate mobile care resource (MICU, Ambulance, or Mobile care professional), or
directing the patient to an alternative fixed resource such as primary care medical surgery or hospital service, or
offering care advice over the telephone
Because of aggressive triage (called medical regulation) , only about 65% of requests to SAMU actually receive an ambulance response.[2] Current performance on emergency calls is arrival at scene within 10 minutes, for 80% of responses, and within 15 minutes for 95% of responses.[3]
This means that SAMU controls a variety of resources within a community from general practitioners to hospital intensive care services.
SAMU is organized at the 'Département' level, with each Department organizing its own service, each of which is identified with a unique code, for instance SAMU 06 in Nice and SAMU 75 in Paris.[4]
Additionally, two SAMU have special tasks :
The Paris SAMU is responsible for providing service to fast trains (TGV) and Air France aircraft, while in flight.
The Toulouse SAMU is responsible for providing service to ships at sea.
In addition to the mainland French Departements, SAMU also operates in most of the offshore American Departements, such as Guadeloupe (SAMU 971) Martinique Guyane or Pacific and Indian French Islands (Tahiti Reunion)
Conclusion
If the United States wants a quilt of healthcare then we need to price together the best aspects of the working systems around the world. Below is a condensed list of what we need to incorporate into our healthcare system based on my review of the Japanese, Canadian, French and British healthcare systems. In my next Healthcare Patchwork Quilt edition I will cover some of the other healthcare systems that the WHO rate as providing better overall healthcare than the current system here in the USA. Remember we are ranked 37th in the world according to the WHO. France, who we covered here today is ranked first in the world. While Japan is tenth, Canada is thirtieth, and the United Kingdom is eighteenth.
1.
Child and Elder Care All the children and the elderly must be fully covered for all their medical needs regardless of how many of them there are at any point in time.
2.
Sliding Scale Fee System All premiums, fees, co-pays, or any other financial outlay by the family must be on a sliding scale based on income of the family.
3.
Alternative Medicine/ Wellness Programs We need to fully fund alternative medicine and wellness programs including traditional Chinese, Japanese, and Native American medicines as well as nutritional programs and programs that treat stress through relaxation techniques including spa and therapeutic massage treatments.
4.
Portability from one state to another is critical in medical coverage as well as portability when transitioning from a status of employed to unemployed. losing healthcare coverage is you become temporarily unemployed or change jobs is totally unacceptable as is having huge premiums that you cannot pay such as the COBRA premiums.
5.
Public/Private Mixture A cooperative arrangement whereby basic healthcare services are covered but elective and experimental services are covered by private carriers would work. Private physicians can provide the services but must charge the people on the central plan only what the government has agreed to pay. Public clinics can be operated only if there are not enough private doctors in an area that accept the central plan to reasonably handle the number of patients for that area. This gives the private doctors incentive to accept the program or deal with the competition of a public healthcare facility.
6.
Federal/State Cooperation States Rights can be honored if we model after the devolved UK model where each state must meet a federally mandated standard of care but can accomplish that by whatever level of privatization of the program that fits the needs of their residents and does not cost more than per capita than a fully socialized model does.
7.
Basic Healthcare The basic standard of care must include a minimum of the following: General Practitioner gatekeepers, hospitalization, inpatient and outpatient mental health, inpatient and outpatient physical, occupational, and speech therapies, preventative and alternative medicines to include nutrition, holistic well being, alternative healing medical procedures such as chiropractic, acupuncture, and acupressure, exercise, therapeutic massage, and stress relief programs, dental to include the most modern best practices but restricting the placement of metal amalgam fillings that contain mercurial compounds, orthodontia and dental surgery, ophthalmology/optometry to include glasses and contact lenses to include up to two pairs of glasses at the same time for children under 16 or a combination of a pair of glasses and a suitable number of contact lenses, all medications whether prescription or OTC with a doctor's order, all best practices surgeries. Best practices surgical procedures will be determined by the central medical board. (see CMB description later)
8.
Solidarity is clearly defined in the French plan as the idea that the sicker you get the more your fellow citizens rally behind you and carry the load for you. Amazingly this very "Christian" idea is incorporated into a socialist styling of medical care. Solidarity is vital if we are to improve the quality of healthcare for everyone. Therefore the sicker you get the less is expected from you and the more the community does for you in order to help you recover. Solidarity in France includes the government requiring the employers to pay a portion of the person's salary while they are recuperating and the government pays the rest. The individual can take up to one year off and be fully compensated while they do so. The french also see relaxation and healthy living as critical to recovering one's health so they encourage spending time in health resorts or on the beaches in the southern part of France as part of the recovery process if you are expected to fully recover from your illness. Solidarity expects that you would understand when your neighbor needs to do likewise for their health. Solidarity also means fully supporting those who are not going to recover. Once a person is found to be in a state where recovery is not going to occur they are released from employment and fully covered by their fellow citizens. The government pays for all their needs in the most cost efficient way possible. France does not have huge nursing homes however. The feel the lack of human dignity in such facilities is unacceptable. They have facilities more like apartment buildings that they can require a fully subsidized person to move into if they have no other family members living in their home with them and they still have financial obligations such as a mortgage. If the only expenses the person has is basic utilities then the most cost efficient method is home based healthcare and family centered healthcare where a family member has their pay subsidized by the employer and the government to stay with and care for their sick relative. This is only used if the person is expected to live less than a year in their condition.
9.
Family Support Services This is a program that while not under the auspices of the actual medical authority is a critical part of the care given to new mothers and their babies. Home nurses, home care workers, and all medical needs are fully covered. This, while costly, can easily be offset by the reductions in the number of foster care homes required for abused and neglected children. Also the government subsidizes child care so the mothers can return to work and pay taxes. The subsidized day care facilities are not required and a mother can take up to an entire year off while receiving full pay from the combination of her job and the government subsidy. However, after that year if she stays home her income is reduced for the next year and after that she gets no pay at all and can be released by her company. The child's care is still fully funded but her medical coverage sees an increased co-pay because her job is no longer subsidizing her care. Private insurances will often pick up the slack if they already have a policy in place in order to allow the mother to stay with the child up to five years. At that point in time the child begins preschool and the mother is expected to return to work.
10.
Government Responsibility Ultimately the federal government will be responsible for administering the mandates for the program and providing the majority of the funding to the program. The federal government will choose a board that will decide the scope of care provided by the program which must include full coverage for the services defined in the basic health care section. They will be the group that decides the best practices options of care and shall be required to provide a minimum of three options for every illness if there are that many available with at least one option being a holistic/naturalistic option. Best practices surgical procedures must include newer and experimental surgical procedures with a 60% success rate in cases with a similar profile to the individual being treated and pre-approval is required unless the procedure must be done within 30 days in order to save the person's life. Individual doctors have the final call on whether they feel they can wait or not and will be paid for the procedure as long as the patient survives. If the doctor acts without prior approval and the patient dies the doctor is not eligible for reimbursement from either the family or the plan. He may however, list the procedure as a medical loss in his accounting statements and be eligible for tax relief due to the loss. All income is taxed to cover the cost of the program. No person can be refused treatment at the point of service for a lack of ability to pay immediately. Co-Pays will be deducted from wages directly if not paid within 60 days of the visit with the amount to be deducted not to exceed 0.25% of the net pay after all other deductions and will continue until the full co-pay is recovered. No company can terminate an employee for allowing their co-pays to be paid this way and employees can opt-in to automatic deduction of their co-pays under this plan.
11.
The Board The medical board of the plan will be a permanent feature of the program however, membership is by appointment, paid for days of active service at a nominal fee not to be construed as employment and entitled to no government benefits. The board shall be made up of actively practicing physicians and medical research physicians who work with the plan. No doctor may sit on the board at the same time that they sit on the board of any for profit medical related corporation including Drug Manufacturers, medical supply companies, or medical information systems companies as well as any other company that supplies the plan with any type of service other than direct patient care. The board shall not have power to negotiate remuneration or approve any form of purchases. the sole purpose of the board is to develop the guidelines for care.
Terms on the board shall be limited to no more than 6 years and no member may serve two consecutive terms. The board shall consist of a minimum of two research professionals one in mental health and one in physical health. It shall also consist of the following who are actively practicing physicians within the system: 2 general practitioners, 1 pediatrician, 1 developmental pediatrician, 1 OB/GYN, 1 Urologist, 1 Developmental Delay Specialist, 1 representative from each of the outpatient therapies such as speech, occupational, and physical, 1 representative from all approved alternative medicines, 1 nutritionist, 1 psychiatrist, 1 dentist/oral surgeon, and any other specialists as needed including cardiologists and orthopedists.
12.
SAMU We need to bring our urgent and emergency care closer to the SAMU model. This model includes in-home treatment of contagious illnesses that ultimately reduce overall healthcare costs by reducing exposure of the healthy to the sick. SMAU has various levels of at the scene care including the MICU which reduces the need to transport unstable people until they can be stabilized using ICU techniques in the field with highly trained doctors manning these units. The snatch and run model may work well on some types of situations but the stabilize and ICU procedures would work better in numerous cases. It is well worth the investment for the higher quality of care that can be delivered at the initial point of contact. Ask yourself this, would you rather have a paramedic with maybe a year of training in medical care and a few months in cardiac care or a physician with 2-3 years of medical training and as much as 10 years experience in Cardiac care treating you in your home when you are having a heart attack? Me, I want the doctor and all the equipment in his mobile ICU along with his undivided attention which is something I cannot get in a hospital.
So now we have the beginnings of a patchwork quilt that might work. We will add to the quilt later as we visit other countries to look at what they are doing right.
