That would be former Governor of Montana Brian Schweitzer.
Way back in early 2009 as the healthcare debates were heating up, I undertook a study of the history, successes, and failures in the US health care “system.” The more I researched and did back of the enveloped calculations, the more convinced I became that even single-payer (which wasn’t even an option) wouldn’t be robust enough to deliver Universal Health Care at a national cost anywhere near what other countries spend on national health care.
The OECD reported the comparative costs of health care among western countries, most with some system of UHC. What’s particularly striking is that in 2009 (not too different from the 2008 report that I consulted) the US spent more public dollars, on a per capita basis, on health care than all but two of the comparative countries. More public dollars (along with a lot more private dollars) and we weren’t even close to providing UHC.
As bad as those comparative numbers are, they would be much worse if the US senior population percentage were similar to that in most of the comparative countries. The US senior population in 2009 was just under 13%; whereas, it was 15% in the UK and 17-18% in several European countries and 20% in Japan. I wrote a series of diaries on why we can’t get from “here” to “there” (UHC) with health insurance reform.
I ended the first diary with:
Stay tuned (only because this diary is already too long). In the interim think about Detroit, Swine Flu & Single-Payer. Two buzz words: public and free.
From the fifth diary
How can we not see that US public health facilities, Community Health Clinics and free clinics are the only viable key to expanding access and affordability to the tens of millions of Americans that have been left behind by The Best (and most expensive) Health Care in the World?
Montana has put something similar to the test:
A year ago, Montana opened the nation’s first clinic for free primary healthcare services to its state government employees. …
He and others faulted then-Gov. Brian Schweitzer for moving ahead with the clinic last year without approval of the state legislature, although it was not needed.
How’s it working for those state employees and retirees with health insurance?
Visitation is more than 75 percent higher than initial estimates.
“For goodness sakes, of course the employees and the retirees like it, it’s free,” says Republican State Sen. Dave Lewis.
And because it’s free to patients, hundreds of people have come in who had not seen a doctor for at least two years.
Hill says the facility is catching a lot, including 600 people who have diabetes, 1,300 people with high cholesterol, 1,600 people with high blood pressure and 2,600 patients diagnosed as obese. Treating these conditions early could avoid heart attacks, amputations, or other expensive hospital visits down the line, saving the state more money.
Pretty darn well.
How’s it working fiscally?
Even so, division manager Russ Hill says it’s actually costing the state $1,500,000 less for healthcare than before the clinic opened.
Pretty darn well.
Free is critically important. As I surmised, it is attractive to certain people and population demographics with health insurance. Free of the billing tasks, doctors and nurses can deliver more patient care in the same number of hours. That alone eases the shortage of primary and preventative healthcare providers. The bonus comes with early treatment of conditions that will be much more expensive to treat later.
Well done, Mr. Schweitzer! A mighty fine first step outside the health insurance closed maze.
Booman’s brother wrote a book on this, reaching the same conclusion:
http://www.amazon.com/gp/aw/d/1609945174/ref=redir_mdp_mobile/188-8322660-5380839
It’s my preferred model, and has been since I researched the issue in 2007. I had to, being young in college and hearing all the bullshit around me. Of all the issues this one is probably the one I know the most about. Community health clinics or a VA-style is really my endgame. Single payer would still be a nice stopgap.
The VA health care system is similar to England’s NHS. However, the price tag is not exactly a recommendation for using it as a model to be replicated. That said, the quickest and easiest single solution to the whole damn mess is to nationalize it — and that would cause even white liberals to scream.
The only part of Schweitzer’s plan that I’m not wild about is the partnership with the private provider — but at as an experiment in proof of concept, it’s fine Maybe more than fine if the dumbasses in state and federal government would get it that $1 in direct grants to Planned Parenthood would save more than that $1 in ACA Medicaid expansion, particularly if medical services at PP were free.
Would prefer that local public health agencies operate the generic free clinics. And that they are affiliated with a local public hospital. That’s one aspect of HealthySF that’s superior to the federal funding of stand-alone community health centers.
I’m sure that the partnership with the private provider was the only way to make this particular experiment palatable to the legislature. As someone who for all practical purposes is a reformist, I’ll take it as a start. I’d love to see health care nationalized in the US as well – not exactly a politically correct thing to say for the time being, I realize. In the meantime, baby steps, I suppose.
Agree — but it’s dangerous because humans like simple solutions and tend not to perceive the critical elements that make something work. It’s why it was so easy for the banksters and oligarchs to convince the public and elected reps that the New Deal regulations were obsolete. The public and elected reps simply didn’t grasp the foundational components of those regulations.
Coincidentally, an ER doctor friend blasted this around yesterday.
Appreciate that, but it sort of ignores the fact that on a per capita basis, the current Medicare system is the most expensive on earth. If other countries with UHC spent anywhere near the annual per capita Medicare cost for their senior population, they too would be broke.
Starting from “here” with single-payer, everybody covered, would lead to everybody demanding what the most expensive providers offer today. That’s exactly what happened when Medicaid was “reformed” in the early 1990’s. Public health care facilities such as LA County/USC Med lost revenues as those public Medicaid dollars were “spent” by the beneficiaries at private facilities.
All the data that I have seen about Europe indicates that doctors are paid about half of the pay that US doctors command and Japanese doctors even less.
And, of course, everyone knows that drugs, including US patented drugs, are far cheaper in Europe and Canada.
US primary care physicians generally earn less than those in Europe. It’s the specialists in the US that earn the big dollars and that’s one reason why in some specialties there are too many of them and too few primary care docs. It may be the overuse of drugs in the US and less premium paid them that’s the larger problem.
It’s not intuitively obvious that free and public primary health care services (to patients) could significantly cut total US health care costs, improve patient health outcomes, and pay the doctors and nurses better than what most of them currently earn.
This CNN report on “rehab” facilities is but one example of why I’m hostile towards privately operated “health” clinics/centers funded by public dollars. It’s similar to the private “educational” institutions living off public student aid grants and loans.