Role of Providers in Health Care Reform

In my mind, based on personal and familiar experience, the jury is still out on the motivation of physicians. I've seen the work of some good ones, but I've seen the disasters caused by probably more of them who were driven by the need to maximize revenues through all aspects of the "medical-industrial complex" ( a term that I coined many years ago).

It is probably quite true that over-treatment also comes from the need to practice "defensive medicine". Again, I concur that computerizing and standardizing, and making universal access to medical records would not only create efficiency in resource use, if the hospital and clinic administrators truely want this (and remember physicians invest in health care facilities), but could also be helpful to physicians in determining "best practices" and could be most useful in medical research. Sometimes, I wonder though, if medical research has not become a self-perpetuating "industry", with largely diminishing returns.

Most hospitals are not-for-profit, but there has been the insidious entry of for-profit corporations onto the scene in the last twenty to thirty years. Certainly, there is no room for profit in any aspect of health care. (I leave room for not-for-profit organizations). Also, the need of non-profits to compete with regards to the latest technologies and the updating of physical amenities has been a huge driver in the escalation of health care costs. There are far too many hospitals and they are far too redundantly equipped with a lot of what could be considered unnecessary technologies. Only by pooling the equity and assets of hospitals, clinics, etc. can we correct this situation and ratchet down the costs of health care. This is the beauty of an equity union and the private sector participation is necessary from not only a payers' perspective (i.e. "double payer" system), but especially with respect to reining in the costs associated with over-utilization, be it from provider abuse and/or defensive medicine.

I paid dues to the Physicians for a National Health Plan (PNHP) for a couple of years. They make some excellent points about the inefficiencies and ineffectiveness of the current health insurance industry. I agree that great savings could accrue from reforming said businesses (again, a combination of for-profits and non-profits). However, PNHP has yet to acknowledge and speak to the abuses on the Provider side of the equation, except to criticize the pharmaceutical industry.

Let's see more talk and writings from the Provider Community concerning their role in the continuing tragedy and impending disaster of the health care system in the USA.

Then there is all the issues of environmental, and thus public health, a subject of another, very large, discussion.

I'm a Work kin for peace and cooperation.


With much love and care,

Mike Morin

Markets

Under my cooperative commnunitarian plan, there will still be markets. They will be localized to the greatest extent possible. The differences between the proposed, and the status quo is that the means of production and distribution will be owned by an association of cooperating inter-community locally based community/worker cooperatives.

I envison a "double payer system " where an Equity Union replaces the current for-profit equity trading and investing paradigm and lending institutions, with a not-for-profit (business entities make profit, but the profits are ear-marked for the start-up of new community/worker hybrid cooperatives.

The other payer, besides the Equity Union, would be the government which would make direct payments from the treasury to poor folk for work, including the supplementing of funds for the worker equity contributions to community/worker hybrid cooperatives.

My philosophy on labor goes back to the French Physiocrats of the 1600's who postulated that natural resources were the basis of all wealth, which is consistent with Marx's "Labor Theory of Value" in that human labor is a natural resource. All productive work is done by people and machines built by people. (Draft animals are a natural resource as well). What my system eliminates is money begets money. Allocation of financial resources will be a job for workers in the new system, but their compensation will be wages and equity participation in the new system, not personal profits.

I am not Suggesting State Socialism, which was really more closely akin to State Capitalism except that surpluses (in the Capitalist world called profits) were earmarked as I have suggested.

Few of the Soviet era economic systems approached the cooperative communitarian ideal (local, and syndicalist control) that I am proposing. Perhaps Yugoslavia came the closest.

The Mondragon Cooperative Community system in the Basque region of Spain is a worthwhile, currently functioning model.