Sunday, June 21, 2009

The future of Health Care

The most ridiculous health care system I've seen in my reading of alien romances and futuristic romances is to put an injured or sick person into a smart box for a short time.

Like magic, they recover completely with no explanation. All the hero has to do is carry the heroine to the nearest box. Or vice versa!

Superheroes and new agers require crystals. What else have you seen in speculative fiction?

Could an MRI or the combination of radioactivity with a psychically attractive meditation object really stimulate the body to regenerate itself?

Or will doctors and nurses always be with us? And if they are, will they dress differently... because those white coats or scrubs that are worn all day long might be the modern equivalent of the unwashed hands that went from dissecting cadavers in the morgue to the childbed in the maternity ward.

It would be nice if Go To Meeting Dot Com technology could be adapted for sick patient consultations, wouldn't it?

Go-To-Doc dot com.

We could sit at our computers with the camera on, and the doctor would be at his computer. We could show him our tongues, throats, nostrils, spots and rashes, hemorroids (I never could spell that!), or anything else that bothered us.

I dare say it wouldn't be too hard to have a DIY stethoscope, ECG, and blood tester. Also a DIY urinalysis, and occult blood test. Pharmacies could sell kits.

My vision is that this would be like Triage. If the patient wasn't satisfied, or if the doctor was suspicious of his or her own diagnosis, a referral could be made. In many cases, we go to a walk in clinic, the doctor pays close attention, prescribes an antibiotic or an over-the-counter remedy, admonishes us to rest and drink lots of non-alcoholic liquids, and tells us to come back in ten days if the condition does not improve.

There's already Ask-A-Nurse by telephone and probably in chat forums. Why not have Doctor-Zoom (with apologies to Legal Zoom) ?

It seems to me that medicine is Socialized on the USS Enterprise, on Babylon 5, and on Rebel alliance starships. Did Luke have to pay for his bionic hand? Would Mr. Spock be required to pay privately if he elected to have a medically irrational ear job?

Being sick is bad enough, without it being financially ruinous. On the other hand, perhaps we don't all have the right to be as beautiful and sexy as modern medicine could make us... at least, not at taxpayers' cost.

What would happen to society in the future if the person who communicated a disease was financially responsible for the treatment of those he or she infected? Unworkable? Unenforcible?

Look at H1N1. Some cities closed the schools.

It's a fact of life. Some parents will send their children to school when they know that child has a fever and is infectious... even with H1N1. There is no economic disincentive to endangering the community, but there is a financial incentive. If the child is kept at home, the parent cannot go to work and may lose wages.

Some people have a cock-eyed view of social responsibility. We had a school camp. One parent allegedly (so others said) left the bedside of a husband who had a 104 degree fever and alleged swineflu to come to camp and take her turn serving food at the snack table.

If the health care system is in financial trouble, will the elders of the future seek to encourage and even reward "self-quarantine"? Or, in the future, would the spread of a deadly disease be seen by government as a cost-effective way to eradicate the most expensive and non-productive members of society?

(Playing Devils Advocate, here. That is not what I endorse.)

My Fictional Future Health Care Plan

1. Private Pay. Walk-In clinics.

If anyone wants to see a doctor in the walk-in system for cuts, scrapes, colds, flu, bronchitis, drug testing, rashes, broken toes/fingers, flu shots, prescription refills, (the sort of things that the uninsured take to the Emergency Room, and everyone else "walks in" and claims on their insurance, which cannot possibly be efficient in terms of paperwork time in relation to face-time with the doctor)

Flat rate of $10 for up to 10 minutes face-to-face online, or $30 in a facility.
(Or whatever AMA deems reasonable... Perhaps tax CREDITS could be an answer to the discrepancy in what people can afford to pay, and what is fair compensation for long, expensive training.)

Cash payment before being seen (on the spot or online).
Medical PayPal model?
Sign medical waiver, so there is no insurance/malpractice issue.
No insurance forms to be filled out, or claims to file. No exceptions. Just like walk in flu shots.

This will save doctors a lot of paperwork.
This will put the onus on patients to turn up at the clinics or online with all their own records and a list of their symptoms.

Health Care Spending Account. PayPal for Medical costs.

Everyone (even children) may set up a tax-free, personal, individual Health Care Spending account, on the same principal as a college account. Possibly, the state could match savings for the lowest income individuals. The dollars would "roll over" and never be lost (unless spent.)

Employers could "buy out" existing health care, by transferring cash into their employees' Health Care Spending Accounts.

This would be a private pay system. Those who keep themselves in good health would not be subsidizing those who have unhealthy lifestyles.

Private Insurance. (Like the British BUPA)

Individuals could opt to buy private, annual, term insurance for operations and other expensive procedures, also for elective and cosmetic procedures. This would be for patients who did not wish to wait for hip replacements, and other elective procedures, or who wished to have annual physicals at "resort" hospitals such as the Mayo Clinic instead of in their local physicans' offices with "participating providers".

It could work like car insurance, with cash back for people who do not make claims, and reduced premiums for those with clean health records. Premiums (at the Health Care Account owner's sole discretion) could be paid out of the Health Care Savings Account.

State System.

Everyone is covered for everything requiring a referral from the $30 walk-in or $10 online clinic and upwards. Everyone waits their turn. No penis or breast enlargement (or reversal of medically successful cosmetic surgery) etc.

Only prescriptions that are necessary for pain, life preservation, treatment of infections, functioning of tests, etc would be provided. (No self-esteem drugs, no birth control, no viagra, no fertility drugs.)

Catastrophic care would be covered.

What's on your future wish list?

Rowena Cherry

1 comment:

  1. "What's on your future wish list?"

    Humira at less than $1500 a month.