Commentary on Managed Care
(licensed vs non-licensed de facto practice of medicine)



"Managed care is a social experiment involuntarily imposed upon a group of unconsenting subjects... the physician and his patient." Anon.

Tuesday. December 30, 2008

Commentary by
Roger S Case, MD

(Health Officer, Island County & Commissioner, Whidbey General Hospital)


This is the eleventh in a series of commentaries addressing the subject of the funding of (y)our medical care, and what we as wage earners (and businesses) can and must do to regain control of his/her/our healthcare dollar.

Friday, 18 April 1997

  Saturday, 26 April 1997

Saturday, 11 April 1998

Friday, February 15, 2002

Friday, 11 July 2003

Saturday, 7 January 2006

Friday, 10 November 2006

Sunday, 18 March 2007

Wednesday, 13 February 2008

Wednesday, 30 April 2008

Tuesday, 30 December 2008

Monday, 29 June 2009

Sunday, 16 August 2009

Monday, 26 April 2010

Monday, 15 November 2010

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We are facing a new era with our new President, Barak Obama, promising a revised plan of health care in America. "Access for everyone". "Health care we can all afford". And we are in the early stages of the greatest recession/depression in the past 60 years... perhaps even worse than 1929....

So what do we really face in making health care affordable for everyone? As I mentioned in my last commentary, there are numerous ways to address the funding of health care, but each citizen needs to make his/her voice heard on this issue. Talk to your employer, your health care provider, your hospitalís leaders. If we donít address this issue now, we will most certainly have to address it in the near future.

Supposing the folks of our county were to decide to self-insure, placing all their health premium payments into the Community Health Plan. There is certainly population enough to make this a viable option. There would be no great buildings or huge staffs to maintain; there would be no outrageously paid CEO and "C-Suite" staff to siphon off non-medical care dollars; there would be no hidden costs, complicated forms, or those many "gotcha" clauses.

Instead, there would be incentives for folks to live healthy life styles. Premium reductions for folks who exercised and stayed within their 'healthy' weight limits, got their regular preventative medicine check-ups, immunizations, mammograms, regularly attended classes on proper diet, food preparation, etc. Parenting education and proper care for children birth-to-five would prevent much of the follow-on ill effects of inadequate and/or improper childrearing that we have seen so much of over the past few decades.

Bottom line: paying ourselves by living healthy lives would not only reduce the demands for "illness care", thereby making more time available for those requiring health care, such a plan would keep all the funds "local" and in play for those actually providing health care services. Such a plan could be truly local (island/county wide), or even manageable up to the state level. It would certainly NOT work at the national level, requiring too many 'middlemen' and too far away for local oversight of the program, which is an absolute necessity to limit the potential for corruption.

President elect Obama is looking for ideas to improve the accessibility for health care. I posit that health care is a local issue, and the solution should be as local as we could possibly make it. Community Health Plans (a self-insuring model) with premiums pegged to living healthy life styles, the use of Health Savings Accounts, and local oversight of the Plan's operation would direct almost ALL the premium to true health care.... not to providing incomes to folks whose interests in "health insurance programs" are merely a way to make a living without a care in the world for the health of the premium payer ó you and I.

We can do this... but to do so requires your attending local/community meetings and discussing the pros and cons of self-insuring. Companies do it... so can we as an island community. Give it some thought. Perhaps you have a better idea. Participate. The health you preserve is your own.

I close with my usual admonition: Only an informed, concerned and enjoined public will be able to effect change. I caution you... keep yourselves informed. The real revolution in health care lies ahead. We are all going to be affected by the change, so each of us must become involved! Don't tell me you don't care, or that it can't be done!

Roger S Case
, MD, FAAFP, retired Family Practitioner

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