What does it actually look like? Or, let me be more specific: How is a universal healthcare system different from the way that an HMO functions?

With an HMO the bar is set pretty low for what kinds of treatments will be covered, what kinds of tests can be ordered, procedures, etc. Step out of network and the world is your oyster. A physician can order any tests they want based on their clinical diagnoses and it is the physician that manages the care of the patient and not the insurance company working within the strictures of a managed care plan.

So if the government now makes healthcare something that all Americans can get, what does that kind of care look like and how would it actually work with a privatized system? Will not the government adjudicate the treatment plan rather than the insurance company? The theory seems to be implausible and seems to transfer the problem of managed treatment from the insurance company to the government.

Think of it this way. We can give a piece of cheese and a loaf of bread to every person in the world once per week with eight glasses of clean water to drink every day. If we can do that (and we sure can somehow with rally low cost it would seem) can’t we officially officially say that we have now solved world hunger since everyone is now eating something within a seven day period and drinking enough clean water every day. Does that really solve the problem? I guess it depends on what you might think a good resolution to the problem actually is. I am not convinced that a managed care system that forces physicians to answer to an agency to administer proper care is all that great - government controlled or otherwise.

Here is a personal story, I have a few, but this one stands out. I had clear Lyme disease symptoms sans arthritis last summer. I had the rash, chronic fatigue, and vertigo. We caught it nice and early before the real bad stuff could take hold. We went to the ER and my blood titer came back negative. Great. We know that to be the case with Lyme. Blood titers have a habit of not proving positive which is why you default with the clinical diagnosis. The ER doc rightly put me on doxycycline for two weeks which is the standard treatment among many infectious disease specialists. But this was only “precautionary” since the blood titer was negative.

So I saw my PCP a week later and to our amazement the rash started to quickly dissipate upon introduction of the antibiotic. The doc was confused that the blood titers were negative and that I had no arthritic symptoms. Also, we are not in one of the Lyme hotspots so probability was not in my favor. So he ordered some more cookie cutter titer tests as a “precaution”. Meanwhile my symptoms were actually worse soon after anti-biotic treatment (which I later learned is called the Jarisch-Herxheimer reaction - another clinical confirmation of Lyme bacteria).

So these test came back negative too. He then tested me for HIV and other things. These were also negative. He was not convinced that it was Lyme even though I presented classic symptoms including the rash. His next stop was an RA specialist and he was not all that approving of my going out of network to see a Lyme specialist (the only two I found were about three hours away). He also said chronic fatigue was a possibility. Of course the message that I continued to tell him was that none of these symptoms existed before the rash in the first place! So yes, the doc may be ignorant. But his demeanor was telling me a different story that I had to learn later…

Screw the HMO. I went to a specialist. The specialist refuses to be a part of an HMO because they would not approve of tests he believes will root out the cause of the problem rather than look at the symptoms. So I took a battery of tests. Two months later he gave me the picture of one one of other possible co-infections. This was bartonella which would also explain my weakened immune system. Photographic evidence this time.

If I had stayed in network I could not have had these tests ordered because the initial titers were negative. They would never approve if it and so, the doc would not even think about it. It goes beyond the question of whether or not my PCP is just ignorant. Without privatized care, we will cripple our ability to perform these kinds of tests enabling us to perform the best treatments - an ability that insurance agencies in the context of HMO’s has crippled well enough it seems.

It seems that improving our current privatized system is the best route to go. Not sure how, but I don’t like the alternatives that liberals tend to espouse.