As a registered and former school nurse, I have always said that using schools - especially elementary schools, as a location fora community based health clinic would go a long way in taking care of each and creating community.
Are you familiar with School-Based Health Alliance https://www.sbh4all.org? I've long thought that it could be a way to rebuild primary care by making primary care available to students, then staff and then eventually the families of staff/students. This is a research article about it https://pmc.ncbi.nlm.nih.gov/articles/PMC3770486/
Don't you think that having multiple living examples of the process and outcomes for almost 80 years provides enough rationale to start one here, especially in light of the trajectory in which our system is headed?
We don’t need to tryout single health payer healthcare by steps. There is overwhelming experience that proves it is superior to profit based healthcare. And many people are dying every day here because we’ve waited too long for universal care.
What business have you been doing for 47 years that makes you an expert in capitalism in the health care economy?
Are you a healthcare economist? A hospital administrator? A private equity wonk?
Id like to hear how you think we can financialize illness, birth and dying, since you’re keen on incentivizing us with money.
Fun fact: German and Dutch physicians make as much as we American docs and with a lot fewer headaches.( plus college for their children and long term care when they’re old)
And the myth about wait times in Europe…we wait here too, or maybe you never heard of prior authorizations or insurance denials?
I’m pretty sure you never heard the term triage, which means treating the worst case first, which is what they do in Europe.
So you may wait for an MRI for chronic migraines, but if you have a head injury you get that MRI right then and there, without having to ask United Health Care.
Explain your point of view- and don’t say I ignored the points in your comment. Restate your position because it was not clear.
Well, the incentives for traditional medicine are healing the patients and treating suffering, so whether “fee for service” ( which means simply get paid for what you do) or some new relative based value scheme with shared risk between insurer and providers based on patient outcomes ( keeping patients from accessing services ), I can adapt.
You and I totally agree on vertical consolidation and the need to break up that chain of incremental profit for the INSCOs all the way up the chain. I bet we agree we need to rid health care of the corporations’ insatiable need to show benefit to the shareholders that afflicts all American business, to our detriment.
You and I probably agree about a lot of stuff but got off cockeyed because we’re frustrated
There is no "overwhelming experience" that profit is the problem. It's way more complex and countries with universal care have their own set of problems. Waiting to get treated seems to be the main hurdle in those "living examples". We are getting closer every day in this country to solving our issues that have produced uneven results. But saying it's the profit motive is intellectually lazy. We need profitable farmers and construction companies, drug manufacturers, physicians, hospitals etc. Everybody needs an incentive.
Hi Tom Laster. As a practicing physician I can attest we are not getting closer to solving our problems with health care in the US, and I wonder why you think so.
What expertise do you bring?
Making an honest living in health care is good, but being a capitalist in health care is wrong. What profit can a capitalist derive from illness and injury? We can’t leverage obstetric or pediatric care for profit- no way. And the old and dying? I challenge you to find a way to make that profitable without hurting our elders.
You clearly don’t understand the healthcare economy, but this author does.
I suggest you look at the German system, and see how insurance corporations can function in an ethical way, when part of a social democracy. Wikipedia is a great start.
Well Doc, you completely ignored my points in the comment but somehow made it through some type of physician training. Good for you. You should practice medicine and let others figure out the financing of care. I "clearly don't understand the healthcare economy"? That's a good one. I have 47 years in the business and I'm getting sarcastic comments from a physician. Stick to medicine Doc. I don't need Wikipedia but you might check out some sites like www.HealthRosetta.org or
Patients Rising or any of hundreds of others that are helping Americans take control of health care costs. And, no, it does not involve insurance. However, it does require transparency and a realignment of incentives so that providers aren't paid based on how much care is delivered or tests run.
Tom what do you mean by realignment of incentives? I mean, we in medicine want to heal patients when they’re sick or injured, and prevent chronic disease by access to primary care from birth.
Our system has been based on fee for service for the most part. What incentives can possibly come from this? And hospitals? I don't even have time to start with how broken the whole thing is. Same with the large health insurers...Minimum Loss Ratio in the ACA guarantees that rates will go up. Look at their stock prices. Pharmaceutical companies? Same story. And all of these players are integrated vertically in the healthcare ecosystem. So we start there with the realignment. It has begun and it is working.
Dave Chase I love this and will follow your work now I’ve found you!
I’m so glad Wendel Potter and you are highlighting these topics.
I have been working for health care access for all in the US since the nineties, as a physician and as a legislative advocate for patients in Texas. It’s a thankless task, but someone has to do it, and I have many doctor friends who are going to love your work when I send this piece.
We are working on school based clinics and community based primary care in Austin- but we’ve had nowhere near the success of your examples.
Now we can dig in to see what we can learn from Nuka and RosenCare and the others.
Your essay was inspirational to a discouraged OBGyn! Thank you.
The market is overwhelmed by boomers aging out of existence and a single payor system doesn’t make sense.
One of the reasons care is so costly is because market demand far outweighs the ability to provide it, creating scarcity which drives up cost, for everyone, even the government.
So while the boomers use blogs like this to try and distract you with tales of the noble immigrant and poor starving children and miraculous single payor solutions, so they can protect their own interests; the fact is they are the primary reason for scarcity.
This has been known for many years and is predicted to peak by 2035.
Moving to a single payor system is a fairly permanent answer to a widely known temporary problem, the boomers.
And don’t tell me about Canada, I have Canadian friends and what I’ve learned from them is that system completely breaks down once you get beyond simple primary care.
People end up waiting months and months and months for any kind of specialty services, tests etc.
🙄Jerry by the time all the boomers are gone you’ll be old and need health care. It’s 100%. We all need care at birth and death- don’t think you can escape it with your snark.
My answer is to eliminate every stinking republicon that exists and replace them all with WOKE. PROGRESSIVE. LIBERAL. DEMOCRATIC. SOCIALISTS., along the lines of FDR, Bernie Sanders and AOC. Nothing less!
It gets a bad rap sometimes but it's one of the top 10 cities for food in the world https://www.timeout.com/travel/worlds-best-cities-for-food and there isn't a city its size in the U.S. that is more bikeable and has amazing running/hiking trails.
Thanks! I'll take it. No wonder Thom Hartmann moved there!
Thom Hartmann and his wife Louise live in Portland, Oregon. He moved from Vermont to Oregon in 2005. He also co-hosted a local talk show in Portland on KPOJ with Carl Wolfson and others, according to Wikipedia.
As a registered and former school nurse, I have always said that using schools - especially elementary schools, as a location fora community based health clinic would go a long way in taking care of each and creating community.
Are you familiar with School-Based Health Alliance https://www.sbh4all.org? I've long thought that it could be a way to rebuild primary care by making primary care available to students, then staff and then eventually the families of staff/students. This is a research article about it https://pmc.ncbi.nlm.nih.gov/articles/PMC3770486/
School based clinics are such a good idea
They did this in a town in South Georgia. Not sure how it worked but agree it sounds like a great idea
Remove the $ incentive. This is a national blueprint. Let's do this
Don't you think that having multiple living examples of the process and outcomes for almost 80 years provides enough rationale to start one here, especially in light of the trajectory in which our system is headed?
Please translate as I am having trouble understanding your point? Thank you!
Great ideas. Getting out of for- profit “healthcare” will need to start small and local.
Insurance and private equity need to to be worked around—by finding another system that actually works.
We don’t need to tryout single health payer healthcare by steps. There is overwhelming experience that proves it is superior to profit based healthcare. And many people are dying every day here because we’ve waited too long for universal care.
Tom Laster-
What business have you been doing for 47 years that makes you an expert in capitalism in the health care economy?
Are you a healthcare economist? A hospital administrator? A private equity wonk?
Id like to hear how you think we can financialize illness, birth and dying, since you’re keen on incentivizing us with money.
Fun fact: German and Dutch physicians make as much as we American docs and with a lot fewer headaches.( plus college for their children and long term care when they’re old)
And the myth about wait times in Europe…we wait here too, or maybe you never heard of prior authorizations or insurance denials?
I’m pretty sure you never heard the term triage, which means treating the worst case first, which is what they do in Europe.
So you may wait for an MRI for chronic migraines, but if you have a head injury you get that MRI right then and there, without having to ask United Health Care.
Explain your point of view- and don’t say I ignored the points in your comment. Restate your position because it was not clear.
Well, the incentives for traditional medicine are healing the patients and treating suffering, so whether “fee for service” ( which means simply get paid for what you do) or some new relative based value scheme with shared risk between insurer and providers based on patient outcomes ( keeping patients from accessing services ), I can adapt.
You and I totally agree on vertical consolidation and the need to break up that chain of incremental profit for the INSCOs all the way up the chain. I bet we agree we need to rid health care of the corporations’ insatiable need to show benefit to the shareholders that afflicts all American business, to our detriment.
You and I probably agree about a lot of stuff but got off cockeyed because we’re frustrated
There is no "overwhelming experience" that profit is the problem. It's way more complex and countries with universal care have their own set of problems. Waiting to get treated seems to be the main hurdle in those "living examples". We are getting closer every day in this country to solving our issues that have produced uneven results. But saying it's the profit motive is intellectually lazy. We need profitable farmers and construction companies, drug manufacturers, physicians, hospitals etc. Everybody needs an incentive.
Hi Tom Laster. As a practicing physician I can attest we are not getting closer to solving our problems with health care in the US, and I wonder why you think so.
What expertise do you bring?
Making an honest living in health care is good, but being a capitalist in health care is wrong. What profit can a capitalist derive from illness and injury? We can’t leverage obstetric or pediatric care for profit- no way. And the old and dying? I challenge you to find a way to make that profitable without hurting our elders.
You clearly don’t understand the healthcare economy, but this author does.
I suggest you look at the German system, and see how insurance corporations can function in an ethical way, when part of a social democracy. Wikipedia is a great start.
Well Doc, you completely ignored my points in the comment but somehow made it through some type of physician training. Good for you. You should practice medicine and let others figure out the financing of care. I "clearly don't understand the healthcare economy"? That's a good one. I have 47 years in the business and I'm getting sarcastic comments from a physician. Stick to medicine Doc. I don't need Wikipedia but you might check out some sites like www.HealthRosetta.org or
Patients Rising or any of hundreds of others that are helping Americans take control of health care costs. And, no, it does not involve insurance. However, it does require transparency and a realignment of incentives so that providers aren't paid based on how much care is delivered or tests run.
Tom what do you mean by realignment of incentives? I mean, we in medicine want to heal patients when they’re sick or injured, and prevent chronic disease by access to primary care from birth.
What other incentives can you think of?
Our system has been based on fee for service for the most part. What incentives can possibly come from this? And hospitals? I don't even have time to start with how broken the whole thing is. Same with the large health insurers...Minimum Loss Ratio in the ACA guarantees that rates will go up. Look at their stock prices. Pharmaceutical companies? Same story. And all of these players are integrated vertically in the healthcare ecosystem. So we start there with the realignment. It has begun and it is working.
Dave Chase I love this and will follow your work now I’ve found you!
I’m so glad Wendel Potter and you are highlighting these topics.
I have been working for health care access for all in the US since the nineties, as a physician and as a legislative advocate for patients in Texas. It’s a thankless task, but someone has to do it, and I have many doctor friends who are going to love your work when I send this piece.
We are working on school based clinics and community based primary care in Austin- but we’ve had nowhere near the success of your examples.
Now we can dig in to see what we can learn from Nuka and RosenCare and the others.
Your essay was inspirational to a discouraged OBGyn! Thank you.
Pipe dream and completely unnecessary.
The biggest open secret is that baby boomers are draining the system.
It will be a bit tumultuous over the next 10 years, but they should be largely gone by 2035.
Then we can see what makes sense.
Re-read my original comment.
The market is overwhelmed by boomers aging out of existence and a single payor system doesn’t make sense.
One of the reasons care is so costly is because market demand far outweighs the ability to provide it, creating scarcity which drives up cost, for everyone, even the government.
So while the boomers use blogs like this to try and distract you with tales of the noble immigrant and poor starving children and miraculous single payor solutions, so they can protect their own interests; the fact is they are the primary reason for scarcity.
This has been known for many years and is predicted to peak by 2035.
Moving to a single payor system is a fairly permanent answer to a widely known temporary problem, the boomers.
And don’t tell me about Canada, I have Canadian friends and what I’ve learned from them is that system completely breaks down once you get beyond simple primary care.
People end up waiting months and months and months for any kind of specialty services, tests etc.
Now you know what makes sense.
🙄Jerry by the time all the boomers are gone you’ll be old and need health care. It’s 100%. We all need care at birth and death- don’t think you can escape it with your snark.
Congratulations, you’ve managed to miss the point entirely. 🤦♂️
Why don’t you explain it to us Jerry? Tell us what makes sense?
Thank you for this most informative piece!
My answer is to eliminate every stinking republicon that exists and replace them all with WOKE. PROGRESSIVE. LIBERAL. DEMOCRATIC. SOCIALISTS., along the lines of FDR, Bernie Sanders and AOC. Nothing less!
And you get Portland.
Hey! that's my hometown 😁 (i.e., where I grew up)
It gets a bad rap sometimes but it's one of the top 10 cities for food in the world https://www.timeout.com/travel/worlds-best-cities-for-food and there isn't a city its size in the U.S. that is more bikeable and has amazing running/hiking trails.
I love Portland. Oregon is doing the hard work. They have an ethical, humanist outlook on the future.
This is a great article! I love hearing success stories in trying times.
Thank you for a well researched and beautifully written article.
Thanks! I'll take it. No wonder Thom Hartmann moved there!
Thom Hartmann and his wife Louise live in Portland, Oregon. He moved from Vermont to Oregon in 2005. He also co-hosted a local talk show in Portland on KPOJ with Carl Wolfson and others, according to Wikipedia.