Sunday, September 1, 2013

(122) Alternatives to Obamacare.......There has to be a better way!



AMDG

       Will Obamacare eventually break the Country?  According to an Associated Press article published in the August 2, 2013 issue of the Gallipolis (Ohio) Daily Tribune, “Ohioans using the new marketplaces created by the federal health care law will pay on average 41% more on their monthly premiums, state insurance officials said Thursday.”  Medicaid (federal and state) will increase greatly to cover the uninsured poor.  Our national debt and huge budget deficits year after year are already unsustainable.  Obamacare may break the camel’s back.  See my Blog #102, "The Choice in the National Debt Crisis: Sink or Swim Together" (http://paulrsebastianphd.blogspot.com/2012/11/102-choice-in-national-debt-crisis-sink.html). Are there other ways to make health care affordable without sinking the economy? 
 
       There has to be a better way.  With creativity and good will, it can be done if communities mobilize their resources to help the uninsured poor according to the Principle of Subsidiarity, promulgated by the Popes since as far back as Pope Leo XIII over 120 years ago and has been so much a part of Church social teaching.  As defined by the Acton Institute for the study of Religion and Liberty (http://www.acton.org/pub/religion-liberty/volume-6-number-4/principle-subsidiarity), this tenet holds that nothing should be done by a larger and more complex organization which can be done as well by a smaller and simpler organization. This principle just happens to be the foundation for personal freedom and limited government that we as a country have held dearly since our nation was founded.
   
        Would community supported neighborhood clinics work for the uninsured?  They could be staffed by a nurse practitioner under the supervision of a doctor for routine cases.  If staffed mostly by volunteers backed by donations, the treatment could be even free.  If staffed by paid health professionals, the patients could be charged on a sliding scale according to family income.  With either model the local, state, or federal government could match private donations without taking control or over-regulating.  Could midwives deliver babies in the neighborhood clinic or even at home under the supervision of an obstetrician on call, who would intervene when complications occur during pregnancy or delivery?

     I first saw this concept in Peru as a lay missionary there for 14 years.  The American Maryknoll Fathers would set up parishes with a posta medica for the poor, manned by a lay or religious missionary nurse.  They assume the role of a nurse practitioner and have access to a local doctor as needed.  I often wondered whether this concept would work here in the United States until we started the French 500 Free Clinic in Gallipolis, OH (http://paulrsebastianphd.blogspot.com/2012/08/91-description-of-french-500-free-clinic.html).  The prime mover, Dr. Mel Simon is in the process of organizing his 30th medical mission of 25 or so volunteer surgeons and nurses since 1985 to his native Philippine Islands (See (http://paulrsebastianphd.blogspot.com/2011/10/dr-mel-simon-career-serving-god-his.html). 
  
     Free clinics for the uninsured, supported by donations, are scattered throughout the country.  There are some 45 free clinics in Ohio alone that belong to the Ohio Association of Free Clinics.   See www.ohiofreeclinics.org and www.needymeds.org for pharmaceuticals.  When doctors and nurses volunteer their time and talent, they make little or no money, but receive great satisfaction and spiritual growth.  This is especially true of retired doctors and nurses, who aspire to have a fulfilling retirement and continue to feel needed and useful, while working on their own terms at their own pace the number of hours they wish.  In Ohio and some other states volunteers in such clinics cannot be sued for malpractices.  Furthermore, patients sign a waiver to protect volunteer doctors against lawsuits.

     In many cases local hospitals cooperate by providing diagnostic tests and lab work either free or at a reduced rate.  After all, it is in their interest to reduce the very large and costly load of having to treat indigent patients in the emergency room, which is the most inefficient way for treating the flu.  In many states non-profit hospitals are required to treat them free of charge.

     Many specialists do a certain amount of free work for patients referred by a free clinic as well as others.  Many doctors write off a significant amount of charges to patients who cannot pay.  If these doctors could obtain tax deductions for the value of their free work, this type of pro bono work would be even more common. 
         
      In some dioceses, Catholic Charities have clinics staffed by volunteer doctors and nurses.  These are either free or the charge is made on a sliding scale according to family income.  The Diocese of Pittsburgh is a wonderful example (http://www.ccpgh.org/page.aspx?pid=295&txtSearch=Free+Health+Care).   There is a certain power when the community mobilizes its resources instead of depending upon Big Government, not to mention the development of virtue and other spiritual benefits.  Too often when Government takes over, it becomes impersonal…….”giving without love and care without concern” while individual responsibility for neighbor is diminished and a culture of dependency is created. 
 
     The Government currently subsidizes a number of medical and dental clinics that charge on a sliding scale according to family income.  For example, Family Health Care Inc. with headquarters in Chillicothe, Ohio (www.familyhealthcareinc.org) served Appalachian Ohio for thirty years on a sliding scale in a number of satellite clinics in smaller towns.  This concept seems to be much simpler than a costly coercive bureaucratic national health insurance plan run by a bureaucratic government with thousands of pages of regulations that depends upon for-profit health insurance companies.

      Recently at a funeral I met Dr. Russell Miller, a doctor in Patton, a small rural town near Altoona, Pennsylvania.  He takes his profession to serve so seriously that he makes once a week house calls to patients who would have difficulty to visit his office.  It’s a real chore to take a bedridden patient in a wheel chair to a doctor’s office, not to mention the strain on the patient.  He aspires to restore the personal touch in medicine.  He also has a number of ideas about organizing community health centers.  What a breath of fresh air!


      Home Care is so much cheaper than putting a loved one out to pasture in a nursing home, but the care giver may have to work or cannot handle the load alone.  The caregiver gives more tender loving care than any expensive nursing home could.  Could the care giver and a relative to help if necessary receive a stipend from Medicare or an income tax credit so that s/he would not have to work?  This would be in addition to a home care visiting nurse which Medicare does provide for.  Typical is Ohio Valley Home Health Care (www.ovhh.org).  Generally, patients are much happier if they can be near family instead of being stuck in a nursing home.  However, the home caregiver must care for her own health and avoid burnout.  The extended family must help.

   Non-Profit Community Hospitals and Charity Hospitals.  The options mentioned so far provide considerable outpatient medical care, but makes little provision for in-patient hospitalization for the poor who cannot afford health insurance.  Hospitals already do a considerable amount of charity work.  In fact about 60% of American hospitals are non-profit and must devote a significant amount of their resources to treat the uninsured poor (http://dailycaller.com/2013/08/08/obamacare-installs-new-scrutiny-fines-for-charitable-hospitals-that-treat-uninsured-people/#ixzz2dghlKOADa).


      Holzer Medical Center in rural Gallia County, Ohio is probably typical.  It gives about a 30% discount to the uninsured who pay out of pocket and charge even less on a sliding scale to the poor.  However, the patient must talk to the hospital social worker first.  It writes off thousands of dollars each year in order to help the poor……about 3-5% of billing.  In some years it operates at a loss.  

      Catholic Hospitals and many other non-profits were originally founded to meet the needs of the poor and continue to do so.  A non-profit hospital cannot refuse to treat a patient who shows up at the emergency room.  Even a for-profit hospital must at least stabilize an emergency case before sending the indigent patient to a community hospital.  Some states as Texas, Arkansas, and Louisiana, including the large Charity Hospital of New Orleans provide medical care for the poor.  In addition universities with medical schools as Ohio State, University of Pittsburgh, Louisiana State University, etc. do considerable charity work or charge on a sliding scale.  See
www.mffh.org/mm/files/hospitalchairtycareissuebrief.pdf - report of the Missouri Foundation for Health on the history and current status of charity hospitals.
  
http://www.stvincentcharity.com/ - St. Vincent Charity Hospital in Cleveland.

http://www.dispatch.com/content/stories/local/2013/01/17/hospitals-charity-care-up-as-are-surpluses.html shows that hospitals of Central Ohio have provided $586 million in charitable care while their surpluses have increased.  Some are criticized on not doing enough.


www.dochs.org - The Daughters of Charity Health System (DCHS) is a regional health care system of six hospitals spanning the California coast from the San Francisco Bay Area.


https://www.oag.state.tx.us/AG_Publications/pdfs/access.pdf - a document of the attorney general of Texas. 
 
    There are many hospitals that provide for the uninsured poor, but this has to be expanded.  There is certainly a need for Charity Hospitals that have charity as their primary mission.  These could be run by religious orders, volunteers, the surrounding community, and state governments with some federal subsidies. They could charge on a sliding scale according to family income.  It would be ideal for every county or group of rural counties to have at least one charity hospital with satellite neighborhood clinics.


      If our society insists upon having socialized medicine, which Obamacare is to a large extent with all of its regulations and insurance financed by Medicaid, then we would have to consider adopting an adaptation of the European/Canadian model.  It would be simpler and cheaper since it would eliminate much of the need for health care insurance and all of the bureaucratic costs and profits that go with it as middlemen.  True, the U.S. Dept. of Health and Human Services would expand.
   
    In Poland, for example, every employer pays a certain percentage of every worker’s wage to the Government, somewhat similar to our own Social Security/Medicare tax.  Patients are taken care of free in Government facilities by doctors, nurses, etc. employed by the Government with much lower wages than here.  Doctors are allotted so much time per patient and there is a waiting list for elected surgery.  The family often pays bribes for better care.  If a patient desires better care, more individual attention, and quicker surgery at a higher price, s/he may go to the private sector in the two tier system.  Doctors frequently moonlight with private practices on the side while employed by government hospitals and clinics.  Since the Government subsidizes medical education, doctors are required to work so many years in the public hospitals at lower wages.  Do we want this or some adaptation of it as in the military in lieu of Obama Care?

       What will happen when Obamacare is fully implemented?  There will be certainly many unintended negative consequences.  Will charity hospitals and free clinics disappear?  Will the health care charity infrastructure be diminished or even destroyed?  That would be a terrible loss to the United States Economy!  And the spiritual benefits will go down the drain along with the energy and resources that a free people of good will in dynamic churches and communities have mobilized in the past.  According to a story in the Boston Globe reported in the Wall Street Journal, Capital Management firms in anticipation of Obamacare are starting to buy up non-profit hospitals to convert them into for-profit cash cows.  See http://blogs.wsj.com/deals/2010/03/25/obamacare-are-charity-hospitals-now-a-hot-commodity/.

    We must anticipate the unanticipated consequences of Obamacare.  How will it affect the economy?  Will there be cuts in social security and medicare benefits to pay for it?  Will doctors rebel against it and leave the profession, thus creating a shortage?  One lamented: “Doctors will quit being doctors” because of its new demands.  The Obama Administration is taking on the Catholic Church regarding the Health Care mandate which is against Church teaching.  Many Catholic hospitals could close rather than conform or pay milliones in fines.  Will the proposed cure to our health care problems be worse than the original illness?
   
       I have tried to show here some alternatives to Obamacare that currently exist and could be built upon and other ideas in a brainstorming mode.  Perhaps they could be combined in some creative way as a first step to a solution.  This article shows that there is a lot of good in what we already have.  Shall we simply throw out the baby with the dishwater?  Or shall we build upon, reform, and improve upon what we have?  What will be the long run consequences of Obamacare upon our national economy?  The American people must become more informed about where our country is headed and decide our general course of action before we reach the point of no return and drive our country into chaos and financial collapse.    







  

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