June 5, 2009

A Taste of the Future of Medicine?

Justin Katz

Long wait times will likely be more characteristic than lotteries, but somehow this strikes me as an extreme vision of the future of healthcare for the average American in a government-run system:

At 4 p.m., volunteers from the clinic came out with a roll of carnival-style paper tickets. They handed each person a ticket and asked them to put their name and number on the stub.

Someone else handed out sheets of paper with the rules in English and Spanish: the Free Clinic is only for people who have no health insurance. They must prove that their income is less that 150 percent of the federal poverty level — that is, less than $2,200 a month for a family of three. The Free Clinic does not care for children 18 and younger, nor does it provide obstetrical care to pregnant women.

Lynne Urbani, the president and chief executive officer of the Rhode Island Free Clinic, addressed the group, saying she would be drawing 14 names in a few minutes, about half as many as usual because there were fewer volunteer doctors available this night. With a translator, she asked them to affirm that they have no insurance and have a ticket in their hand. They nod in agreement. Those whose names are pulled should expect to stay till 9 p.m. Those who aren’t chosen will get a call offering them an appointment; the next opening is in July.

If prices are set, the medical industry will attract fewer professionals. If tax dollars (in one form or another) are the method of payment — filtered through the government bureaucracy — there will be rationing and long delays as financing and demand fail to balance.

In healthcare, we've got a product that people tend to see as an inconvenience when they're healthy and as a dire necessity when they're not. The more the system separates those who pay from those who receive, the more effort paid employees will have to allocate for determining priorities or the more they'll disregard that responsibility and rely on cold process and chance.

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"Those who aren’t chosen will get a call offering them an appointment; the next opening is in July."

They won't need the appointment. In fact, many of those not chosen may be seen by a physician before those that were chosen. They'll simply head on down to Rhode Island Hospital's emergency room and be seen there. RIH can't turn anyone away, so there they'll go!

Posted by: Patrick at June 5, 2009 11:29 AM

Fifty million (50,000,000)of our people are uninsured and outside our medical system, and you carp about the possibility of long lines. The system needs revamping so that all of our people are included. You are trying to cure measles by curettage.

Are you related to Marie Antoinette?


Posted by: OldTimeLefty at June 5, 2009 11:43 AM

What I think is odd is that you don't think these are "average Americans." They seem average enough to me. I take it we should read that as white, suburban, and male?

Posted by: Russ at June 5, 2009 11:51 AM

Perhaps the phrase was a poor choice, but your interpretation is an exercise in ill will, with the introduction of race making it something worse.

Times are hard, but having to submit one's self to a raffle for a doctor's visit is not currently the average circumstance for Americans. The individuals who do find themselves thus situated may be average by other measures, of course. Indeed, some are likely exceptional in one way or another.

Posted by: Justin Katz at June 5, 2009 1:02 PM


I carped about one proposed shape of a reform solution, not in favor of the status quo. Can the difficulties of liberals be explained as an inability to imagine alternatives, I wonder?

Posted by: Justin Katz at June 5, 2009 1:04 PM

Shock! The nerve of me holding "ill will" towards what appears to be bias. I was actually thinking more along the lines of nativism than of race since the article curiously goes out of its way to mention that some of those recieving care immigrated to this country (e.g. "the Nigerian woman with the achy body").

Fact is, many "average Americans" end up without health insurance at times during their life (myself included). Now, had you said "average circumstance," I'd probably not have commented. As someone who seems to choose their words carefully, I still say it's kind of odd that you didn't.

Posted by: Russ at June 5, 2009 1:38 PM
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