Friday, June 19, 2009

Can Healthcare Reform Rescue County Hospitals?

The President's Healthcare Reform initiative is falling flat. Big insurance companies don't like it, as it would find many of them unnecessary. So they squelch ideas that exclude them.

What about starting the reform process by supporting the institutions that are already funded by government and which are starving for funds due to the economic crisis? County hospitals have been turning private for years for want of support. Many, many have already done so. Can we support the ones still in need?

These hospitals and clinics - the bottom line in health care, which are already in place for those who have no money - need rescue.

Rescue The Hospitals. Salvage the Safety Net. Re-shape Healthcare.

"Healthcare Reform" is a vague and nebulous term. The mind instantly knows that it can mean anything. As with a host of other good-sounding government initiatives, one senses that the word is a cover. It can be a cover for anything one wants it to be, for anything that Congress decides that it should be. It's like buying bread in a white plastic bag - you can't see the crust.

It has no auditory mishearings. Back in the old days, "Lawn Forcement" and "Lawn Order" attracted many owners of lawns to support a former cowboy movie star for President. Those without lawns were less attracted. But what does "Health Carry Form" mean? What could it possibly mean?

What are the specifics of ole' "Carrie Form"? She needs some dimensions. Her twin sister "Wealth Carrie Form", who has just had a new jump-suit made for her, could provide Health Carrie's dimensions. They should be about the same.

Nails, we need nails. Bullets are out, these peaceful days, so instead of bullet points, let there be nail points on this, the door of the cathedral.

1) Rescue the Public Hospitals. Let public hospitals stay public. Fund them and help them expand their services to meet the needs of the poor. This initiates movement now.

2) Identify the components in a baseline level of care.

3) Give free baseline level care to those with no insurance.

4) Pay malpractice insurance costs for physicians at public hospitals or who are doing work with the uninsured. Police these expenses.

5) Find failing hospitals, buy them for the government, make them work right.

6) For healthcare clients who wish for a care level above the baseline, let them pay for the special services they would like to have. Let them pool their risk through insurance, if they like.

This is a shotgun approach. A hacker's solution. The idea of a single unified plan has encountered a united front of opposition from those who would be left out in the cold. A shotgun approach can target immediate needs of the growing population of uninsured as those needs become apparent, yet it also would let corporate healthcare organizations migrate into special services over time, rebrand, and rescue their equity.

The University of Chicago Hospitals, a corporate organization, is doing this. It wants to focus on the special cases. Although the Biological Sciences Division and some in the hospital are researching life extension by studying those of us who have lived a while and are still healthy, the hospital discouraged ordinary screening in the clinic I went to, and it converted my screening exams into treatment exams. They want out of the public healthcare process. They are blind to the healthy.

There are already two levels of health care. The upper level is a source of new ideas, new drugs, new treatments, while the bottom level is a sink, an aggregator of cures that become generic, a lowest-cost care dispenser. This is the existing topology. A health care system needs to conform to all its surfaces.

For patients receiving baseline care at a public site who need exotic services, these can then happen at a corporate institution in a controlled, contractural setting.

Rescuing these poor, starving public institutions would be rescuing the poor and starving. This plan can pass Congress, one step at a time if need be. We serve the poor. We can do better. And better again.

We can parachute ourselves there. Call it the Healthcare Parachute. This phrase has "Care Bear" hiding within.

(Added June 25...)

In the interest of furthering the top secret Health Care Bear Initiative, here are more programs that the world yearns for, dressed in warm fuzzy wuzzy clothes.

Can HHS define the common set of Healthcare Parametrics? What are the parameters - the "calling parameters" of functional modules within the healthcare system? For each parameter, what are the metrics that let us govern and evaluate the use of the module? These metrics - when we can decide what they are, when we can look at the structure of the system and decide what we will measure - these metrics are the guidlines that the system will tend toward.

However you measure something, that's how it grows. If a programmer is paid by the line, he will produce a program with many lines of code and include lots of comments. If he is paid by function points, there will be many compound expressions with multiple clauses per line, and the program willbe indecipherable. Whatever the metric, the system optimizes toward it.

So what are the metrics? What are the parameters of healthcare? What are the Healthcare Parametrics that will govern our care system? What will we measure?

Once the Health Care Bear contingent gets the Healthcare Parametrics defined, perhaps they can develop a Healthcare Barometer like those silly threat level gauges (and perpetual announcements) at the airports that warn people to be afraid. A Healthcare Barometer could measure any number of possible forces. Perhaps the pressure for good, simple, healthcare. Perhaps the waiting time at clinics.

Health Care Fairs already introduce Care Bearishness. One can learn about 'Health Care Wheres' at Health Care Fairs.

But for one's Health Care Share, one must take care to include one's Senators and Representatives in one's Health Care Prayers.



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