Society Contents

Healthcare Without Insurance

The fear of "socializing" healthcare is a real hitch to getting anything passed in Congress, and in convincing the America people that it isn't going to ruin healthcare altogether.

The choices seem to be one kind of insurance or another:
  • employer-based insurance
  • government controlled insurance

    But... there is another choice.
    We can set up an entirely new medical structure at a drastically reduced cost.

    There is nothing more private in our lives than our personal healthcare. When we allow a doctor to examine us, it is a relationship of trust... and we hope that whatever is recorded about our state of wellness... and about our body parts... and about our psychological wellness... will remain solely with our doctor and his/her trusted medical assistants.

    With insurance schemes, your state of health is NEVER just between you and your doctor. If you purchase insurance through an employer, those enrollment forms require pre-existing conditions to be itemized. These forms pass through your company's offices.

    In fact, in ANY insurance scheme, one will surrender one's right to privacy... because claims must be handled by office staff at the insurance companies. And, if your private information is in a computer database it becomes accessible to anyone with a desire to find it. Anyone in the "Workman's Compensation" legal system... will find their medical records intruded upon, as well.

    The intrusion goes further. Insurance companies have the power to control what healthcare you can receive, as well as how much your doctor will be paid for his services. They can exclude or include coverage based on their own costs, and if they are included in a universal coverage system, they will become even more intrusive. There is the potential to establish a system of complete behavior control... under the premise of "health impacts." They would have the "right" to know every behavior you practice... because of its healthcare implications.

    And your coverage may well be minimal. Insurance policies are more and more "dummy" policies... you will end up paying a huge chunk of the cost of your healthcare tests and treatments, and not know what your portion of the bill is... until it is too late.

    The present system is completely dysfunctional.

    The high cost of a doctor's liability insurance has been caused, in part, by the lack of oversight of the medical profession... especially in ensuring that genuinely bad doctors are not allowed to continue practicing medicine. We know how lax the system is when we hear a story about a man who stole a doctor's identity and practiced medicine for years...even on FBI agents.

    The process of medical training is insane. Doctors must intern in hospitals in a fashion that can only be described as tortuous... working shifts of long hours with no sleep. More students are seeking to get nurses training than there are classes available to train them in. Thus, we have a real shortage of nurses and the practicing nurses suffer under extreme conditions.

    Small clinics and hospitals have been closing in rural areas because they have no funding. Many rural residents cannot afford insurance, and so they have gone without healthcare.

    Insurance is not an answer.
    But... the insurance-based system is the source of many jobs. Every doctor's office must now have an "insurance specialist" whose sole duty is to submit claims and do paperwork for the insurance companies and government agencies. But this "employment plan" comes at the degradation of healthcare itself.

    Implementing a new medical structure would have to be done in conjunction with the creation of new jobs. This is addressed in the essay
    "Jobs and Businesses."

    A Medical "Eco-system"

    There is an alternative to our dysfunctional insurance model.

    I call this system: A medical eco-system
    It will be initiated by the government with guaranteed loans to form clinics. The guidelines would establish a model of a full-functioning clinic, and coordinate the initial establishing of this system. Once established, the clinics would function on their own.

    It will provide healthcare for every person in the country at $50.00 a month. Yes, that's correct. (Check the math below). And the government's only monitary involvement will be to guarantee enrollment for poverty-level persons and those who do not enroll on their own.

    Enrolling in a clinic IS a person's health insurance.

    They will have their choice as to what clinic that might be and be free to change as they choose.

    This eco-system will eliminate medicare, medicaid, VA, and other medical programs. Veterans Hospitals will be a specialized clinic available within the system... and paid for by the Dept. of Defense from their total budget... but a veterans's basic healthcare will be through a family clinic.

    The system will monitor itself with a Medical Oversight Board working with a State Doctor Referendum (composed of all licensed medical doctors in each state). The Oversight Board will monitor the expenses and practices of all hospitals and clinics, including nursing homes. The Referendum will set salary levels for all medical practitioners and establish standards for all aspects of their own medical community.

    This "eco-system" begins with the formation of family clinics. Each clinic will have the necessary equipment to provide the basic standards of treatments. This includes the more common medical equipment such as x-rays, heart monitors, sonar, and small laboratories... that allow the best and quickest diagnosis of a person's health... on site.

    Doctors will form into groups (choosing their own associates) in order to offer complementary expertise in various fields... general practice, pediatrics, internal medicine, diagnostician, geriatrics, etc. Doctors may bring patients from a former practice, or they can have enrollment meetings where clients can meet the doctors.

    The clinic will associate itself with dentists and eye doctors, possibly even within the clinic. Specialists and surgeons with greater expertise will work out of other specialized clinics or hospitals. Each family clinic would pay fees into a fund from which hospitals and specialized clinics would draw to pay for their expenses.

    There will be an on-site pharmacy at the clinic. Pharmaceuticals will be deductible to the clinic as a business expense, as they are a required tool of this profession... just like cotton swabs and x-ray machines are tools. Thus, medicine would be included in the service provided by the clinic.

    Medicines will be purchased in bulk according to the needs of the clients, and dispensed at the clinic. This enables doctors to personally dispense needed medicines at the time of examination... and will avoid any confusion in filling the proper medications. No one will be able to purchase duplicate medications to abuse or illegally sell them.

    These family clinics will be open 24 hrs a day, 365 days a year... to attend to emergencies and pharmaceutical needs... and to serve working families. Doctors will rotate shifts, or hire interns when needed, to work part-time.

    To eliminate the high cost of liability insurance...
    The doctors of the clinic will have a daily meeting, discussing problem diagnoses and other liability risks. Any problem diagnosis will get a second opinion and as a clinic the doctors will decide a plan of treatment.

    Each clinic can set standards that can reduce the risks of their practice, and negotiate with insurance companies. The liability insurance would be paid by the clinic... as a group policy... encouraging all the doctors to protect their clinic as a group from causes of action against them.

    Management of the clinic
    Enrollment fees are paid to the clinic. From these fees all salaries are paid, as well as the cost of liability insurance, repayment of equipment loans, and other expenses. Each doctor will have a salary that is set by the doctor Referendum for their personal level of expertise and experience. Doctors who relocate to needy regions of a state will be paid bonus salaries.

    There will be an office manager... allowing doctors to practice medicine rather than try to function as a business owner. They will have no overhead for a medical practice. The clinic will function as a whole.

    Specialized and hospital care
    A portion of the enrollment fees to the clinic will be put into a master fund which will be used to pay for specialists, hospital care, surgeries, and other extended services. The doctor and the patient will chose any specialist in the country.

    Nursing homes will draw their salaries from this fund and be closely associated with a nearby clinic. Nursing homes will become non-profit entities. The building and facilities will be owned by the state and maintained by the state, but salaries and all other expenses will come from the master fund.

    Email consultations
    The ability to have email contact with a nurse or a doctor will filter out problems that can be handled without a real-time examination and reduce the load on the doctors. Email will also allow a doctor to monitor new medications with patients if necessary... resulting in better care all around with less effort. These emails can be monitored 24/7 by the medical staff at the clinic.

    Medical records
    All of a clients' medical records will be in one central place, where all doctors can refer to them, and refer as well to other family charts to help diagnose difficult cases. These can be transferred to a USB memory card for patients to take with them... for travel or to treatment in a hospital. The records would be locked with a password that only the doctors will have.

    Health maintenance
    The clinic's nutritionist would work alongside the doctors and the pharmacist to spot signs of nutritional needs as well as put together a newsletter for all patients to inform them about proper nutritional practices. This nutritionist would serve as an informational director for the clinic... to enhance the maintenance of health of all the enrolled patients.

    (return to text)

    The Organization of the Clinic

    The model used below is for a base of 12 doctors in a clinic that is open 24/7, 365 days a year... in varying shifts. In this model, the clinic can provide services for 3 patients per hour for each doctor. (see numbers below) This totals 1404 patient visits per week or 73,008 patient visits per year.

    If each enrolled patient visited the clinic an average of 3 times a year, that would divide this number into thirds. OR... 24,336 patients able to be enrolled in each clinic. Of course, in times of heavy patient load, the clinic can call medical students to assist them.

    Round the number of enrollees to 25,000. With each enrollee paying $50. a month or $600. a year, the total money taken in would be
    $15,000,000. (15 million dollars).
    The total that would go into the master fund would be
    $11,000,000. (11 million dollars)

    12 doctors total
    doctors working each shift
    9 doctors --------- 8am-4pm
    2 doctors --------- 4pm-midnight
    1 doctor---------- midnight-8am
    Saturday and Sunday
    each doctor works 1, 4-hour weekend shift

    Total staff working each shift
    Shift 8am- 4pm
    9 doctors, 2 nurses, 4 med. assist., 3 office
    9 doctors can treat 3 patients per hour =27 patients per hour

    27 per hour times 7.5 hours= 202 patients per day
    times 5 days= 1012 patients per week for prime office hours

    Shifts 4pm - midnight,
    2 doctors, 1 nurse, 1 med assist, 1 office
    3 patients per hour times 8 hrs =24
    24 times 5 days = 120 patients per week
    Shifts midnight- 8am, 1 doctor, 1 nurse, 1 med assist
    approximately 2 patients per hour= 16
    16 times 5 days a week = 80 patients a week
    Saturday and Sunday, 2 doctors, 1 nurse, 1 med assist, 1 office
    2 doctors all day= 2 patients per hour= 4 per hour
    4 patients times 24= 96 patients per day =192 altogether

    Total= 5
    Dentists = 3, 8am - 4pm,
          2, 4pm-9pm, and Sat 8am-4pm
    3 patients per hour times 7.5 hrs= 22 x 3= 66 patients per day
    66 times 6 days=396 plus 75 = 471 patients per week
    24,492 patients per year

    Dental assistants
    Total= 5
    working same hours as dentists
    Office assistant= 1
    Eye doctor=2
    Office assistant=1
    Nutritional assistant=1


    Salaries, these are only rough amounts
    12 Doctors= $5000 per month x12= $60,000 per year
          times 12 doctors = $720,000 per year

    Nurses= 4 full time= $3000. per month = $36,000 year
          times 4= $144,000 year
          3, 16 hrs week= $300. week $15,600. year
          times 3= $46,800 year

    Medical Assistants = 6 full time $2000. month, $24,000 year
          times 6 = $144,000. year
          3, 16 hrs week= $800. month, $9600. year
          times 3 = $28,8000

    Office workers = 4 full time, $1700. month, $20,400 year
          times 4= $81,600. year
          3 part time= $680. month, $8160. year
          times 3= $24,480 year
    Pharmacist = 1 full time= $40,000 per year
    Dentist = 5 full time, $60,000 year
          times 5= $300,000 year
    Dental assistants= 5 full time= $24,000 year
          times 5= $120,000 year
    Office assistant = 1, $1700. month = $20,400 year
          times 1= $20,400 year
    Eye doctor = 2, $55.000 year
          times 2= $110,000
    Assistants = 2, $20,000 year
          times 2= $40,000 year
    Office assistant =1, $1700. month, $20,400 year
          times 1= $20,400. year
    Nutritionist =1, $35,000. year
    Nutritional assistant =1, $25,000. year
    Total salaries= $1,898,880.

    add security= 3 full time @ $25,000 year = $75,000.
          2 part time @ $17,500. year = $35,000.
    Total= $2,008,880. for Salaries

    Building Mortgage Payments=
    $100,000. year

    Loans taken out to purchase equipment for all offices.
    payments= $250,000. year

    Supplies for all offices per year
    $750,000. year

    Eyeglasses = $100,000. year

    Total expenses= $1,300,000.
    Total salaries = $2,008,880.
    Total = $3,308,880.

    Insurance covering all doctors in clinic= $250,000. year
    Clinic's self-insurance account to cover other claims= $250,000. year
    Legal services account = $50,000.

    Total legal and insurance expenses= $550,000. year
    Total expenses= $3,858,880.

    Total take-in: $15,000,000.
    Total expenses: $3,858,880.
    Leaving: $11,141,120. (11 million dollars) to put into the master fund.

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