Where is American medicine going? With a Ph.D. in Management, and after concentrated study of social change trends over the last twenty years, it suddenly came to me like a ton of bricks falling on my head.
Twenty to thirty years ago we had multiple grocery stores in our communities. Some were better than others, some were bigger, but you went in and you got what you needed locally. Then came the big change! You now have the major relative inexpensive chain supermarket conglomerates, etc., where most folks now shop. If you want to pay a little more and parking space is a little less tight, you might want to go to a higher cost, fancier supermarket and get a better quality product. Those willing to spend more, even on special occasions, go to the high-end specialty supermarket, and also to the individual boutique meat, vegetable, and bread specialty stores. For lots of popular choices, but not a full array of all products, that will surely cost more, you have the 7-11's, open late for the customer's convenience.
What we have now is multiple systems of medical delivery with big health care networks that are akin to the supermarkets of the current 1990's era. You have the after-hours walk-in clinics that are equivalent to the 7-11's. You still have the choice to go to the boutique shops if you want to pay more and get the highest quality. They don't accept food stamps, nor does Mayo accept Medicaid. Specialty medical services are an analogy to this boutique consideration.
The only significant difference now is the body. We may yet arrive at what the Clinton's and Bismarck initially wanted, i.e., everybody has a Government-funded Medicare card which allows them to get the final basic necessities and you can then pay extra only if you want to go first class. When the basic financing step is completed we will have the total revolutionary social transformation of American medicine for the 90's.
We should perhaps look to the Australian system where the citizen can now elect to go totally with the government program alone, financed totally by a 11/2 % payroll tax, or take out additional insurance that they can choose to pay for. The additional insurance can go for entitlement for a color TV and a private hospital room, as opposed to the ward bed. Indeed, in Australia, you could take your government "Medicare Card", and the bill you just paid, let's say $100 fee, turn it in, and be reimbursed $80 on the spot.
The local doctor, likewise, can take his bills for ten government funded patients totaling $1,000, and get $800 at the same Australian Medicare office without delay, hassles and paperwork. I doubt that we Americans can ever be that unbureaucratic, but who knows, if we allowed a private company by bid to handle the efficient claim processing for 5% if they do it well and at 3% if they do it poorly, we might evolve a perfect or near perfect system of private/public health care delivery in 2001.
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