They trek in. They trek out. They stop, rest, disgorge their fantastic stories and let us help them; then out they go into the real world again.

Alas were this some fantasmagoric game. Its not. Its a Community Health Center.  We seem to collect them. Its partly our mission and partly our trial.  The health system in the United States has some serious problems those in power have yet to appreciate the depth of the hole, as it were.  If I were not at the center of the swirl, I would stand back and laugh at the machinations of those who worry that government will take over health care with disatrous results.

We are already at disastrous and the only thing that keeps us from total ruin are the government operated and funded programs.  I watched as our health center insurance, after all we too participate in the miasma of private for profit, stockholders take all insurance plans. Ours zipped up a mere 15% and still we face deductibles in the 1000′s, expensive primary care deductibles and rules for use of additional services so arcane that even insurance people can’t figure it out. Kudos’s,  however, to my boss. He split off the rise so that the lowest paid on our staff paid the least percentage increase (perhaps 1-2%) and the highest paid 14-16% increases.  It makes an intolerable situation bearable.

Back to the ballyhoo. Government run programs including medicare and medicaid offer some of the best coverage for care, most uniform although occasionally tricky policies for patients and even on the reimbursement side. You know that if you provide services, sooner or later, within some guidelines you’ll get paid. 

A few years ago one of my private practice insurers sent a note out that the POB had changed for remittences to an adjacent town and another mail box. For most of us it was still the days of paper forms and humans not in call centers who worked the system. The box, no surprise, was a fake. After 4-6 weeks of languishing claims, the company began to get calls about where might be the remittances. After much furfuring, badinage and general lying, it came to light that some miscreant within the company had created this false address. Naughty man! Would we please resubmit the claims, which now had a current zero day for timing – about two nearly three months out from their original date.  Someone made a boatload on that one!

The chicanery doesn’t end with the practitioners. The myriad of plans to medicare recipients, forced into a drug plan which is neither plan nor planned but a ponzi schema with a donut hole. For those of you sleeping under a rock for the past few years, the donut hole is a 5-7000 dollar shortfall which the medicare recipient must make up once the generosity of part D, we can’t negotiate price, plans have run out, leaving the senior holding bag, or readied to make the next payment on the stockholder’s investments.

If I offer a solution, its to step back from rhetoric and revisit a public option plan. Its not necessary to prop up the multinational corporations. We are the only quasi-civilized nation to be so hogtied by the greed of our corporations. To be sure other countries have found themselves, recently, at a shortfall because of the ill behaviour of organizations to big to fail, or perhaps to big to continue. 

Consider this:  the health of our citizens, much like their education is an investment in the future of our democracy.