Does Insurance Equal Care?

Two stories in the past week have illustrated how two concurrent philosophies about health care reform are playing out.

In one model, San Francisco's universal plan gives access to care to all the city's residents, but isn't an insurance program. In another, Massachusetts's program is a health insurance plan that covers everyone in the state.

Both have benefits, and challenges. The San Francisco model isn't portable (i.e., you can't get care in another city), so people may be less willing to give up their private insurance. Nonetheless, every resident in the city has access to care - both primary care and hospital care. The Massachusetts model has provided coverage to everyone in the state, but they're coming face-to-face with the very real challenge presented by the physician shortage - some care centers have waiting lists 150 people deep.

Time will tell which of the models will prove the most effective (indeed both may). But the greater philosophical question is one worth contemplating: Is it better to use the broad coverage option offered by Massachusetts or to utilize a smaller, neighborhood-style approach like San Francisco's? Is it a "nationwide" program that will solve the crisis or a "tribal" one? 

Comments

[Carol Bayley]

Imagine a highway system that varied city by city, or even state by state. Or the post office. Or the military, for heaven's sake. This is crazy. There are some things that only make sense if they are national in scope, and health care is one of them. We need a system that is fair (since none of us "deserve" the health status we end up with), portable (since jobs move and so do we), rational (since prevention is cost-effective and there is a lot of money wasted on administrivia and overtreatment) and disengaged from employment (since the great engine of capitalism runs on a certain amount of unemployment). What San Francisco and Massachussetts are doing is to help individual people from drowning; what we need to do, together, is build a ship that will actually float.

[new balance]

In silence,in steadiness,in severe abstraction, let him hold by him-delf, add observation,patient
of neglect,patient of reproach, and bide his own time,happy enough if he can satisfy himdelf alone that thia day he has seen something truly.Do you understand?

[Nike Air]

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