Healthy alternative

"Healthy alternative" Continued...

Issue: "MS-13: Criminals next door," June 18, 2005

According to University of Alabama historian David Beito, in 1920 nearly one-third of adults over age 20 were members of fraternal lodges that typically contracted with a general practitioner to provide medical care to members who paid one or two dollars a year for coverage of themselves and their families. For example, on the Lower East Side of Manhattan "500 doctors had contracts with Jewish lodges alone. During the 1920s, there were an estimated 600 fraternal societies among blacks in New Orleans that offered the services of a physician." By the 1930s, though, "lodge practice" faced increasing competition from insurance companies, government programs, and medical associations that "launched an all-out war against lodge practice. . . . Old relationships of voluntary reciprocity and autonomy [gave way before] impersonal bureaucracies controlled by outsiders."

Whether clinics like Zarephath signal a return to mutual aid, as the Ecks would like, depends a lot on forces beyond their control. Will Congress enact policies that encourage innovation and provide incentives for doctors to provide charity care? All doctors aren't like the Ecks, but the existence of only 17 low-cost clinics like ZHC in New Jersey shows both a lack of incentives and the presence of disincentives.

Many doctors who have the time and inclination to help are averse to putting themselves at risk. A newly implemented law, the Free Clinics Federal Tort Claims Act, allows federal health officials to declare volunteer free-clinic doctors to be, for purposes of malpractice insurance, employees of the Public Health Service. That should help attract doctors, especially retired or unemployed physicians who don't have malpractice insurance, to serve at free clinics.

Free malpractice insurance isn't a panacea, though, because clinic doctors face additional risks, including the demand of some state medical examiners for "perfect note keeping" and other practices of defensive medicine that may not be realistic under crowded clinic conditions. Many doctors don't want to bother. Unless they can get state-level legal indemnity, it's not worth the risk to them.

John Eck offers charity care "with fear and trepidation," realizing that an avaricious litigant or power-wielding bureaucrat could make his life miserable-and the larger question is whether policy-makers will value the sacrifices of doctors like the Ecks and make it more likely for others to volunteer. But for now, Amal Gurguis breathes easier, knowing that as long as Good Samaritans like the Ecks exist, she won't be left on the side of the road.

Is there a solution?

A bipartisan panel of 24 political, corporate, and health industry leaders began meeting last October to seek consensus and draft health-care proposals palatable to both Democrats and Republicans. Kate Sullivan Hare of the U.S. Chamber of Commerce told The New York Times, "This effort holds as much promise as any I've participated in over the last decade, probably more." But the group, which includes leaders ranging from the liberal Families USA to the conservative Heritage Foundation, has not yet disclosed a specific plan.

The conservative Cato Institute, arguing that current medical insurance programs create no incentive for smart consumerism and lead to massive waste, is proposing dramatic privatization of health care and the expansion of health savings accounts. Left-wing Democrats such as Rep. John Conyers (D-Mich.), though, continue to insist on killing private programs by requiring all to pay for and accept governmental health care.

Some Democrats have shown a willingness to drop the one-size-fits-all attitude that characterized their party's approach during the 1990s. Meanwhile, some Republicans have softened considerably their initial push to clamp down on state spending-this despite pleas from conservatives who point to lessons learned in the successful welfare budget cuts of 1996.

The Bush administration's proposed 2006 cuts to federally funded Medicaid are modest at best, trimming what the Congressional Budget Office estimates will amount to one-half of 1 percent over the next 10 years. The Bush budget proclaims that Medicaid "will continue to grow at a robust rate." Most observers agree, however, that mere status quo growth of a Medicaid program that promises far more than it can deliver will not solve the ever-increasing crisis.

Health costs are also crippling small and large businesses. General Motors Chairman Rick Wagoner last month said the American automaker spent $5.2 billion on health care in 2004, hurting it in international competition.

Seeking to find some middle ground, Republican governors such as Florida's Jeb Bush and South Carolina's Mark Sanford have proposed restructuring Medicaid rather than scrapping it. They suggest vast use of health savings accounts whereby Medicaid users could keep whatever money they do not spend, providing incentive for prudence.


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