Wednesday, March 05, 2008

California Capitol Fellows

The following is the policy statement I wrote for the California Executive Fellowship Program. The Program awards a staff position to 18 applicants for 11 months, serving in the governor's office. Not a specific question like the application for the Assembly Fellowship (see archives, Policy Statement), the Executive Fellowship application asks aspiring fellows to write about a policy area that needs to be addressed and why. I chose to write about healthcare, but my angle is somewhat out of the ordinary.

Policy Statement
Although there are any number of state policies that could be improved through streamlining and removing layers of bureaucracy, one that is perhaps in need of reform the most is healthcare. More than just the oftentimes insurmountable levels of red tape, the healthcare system in California and elsewhere rests on a paradigm that is abjectly unfair. It pits the two most experienced players in the game, the insurance industry and the caregivers, against the least experienced, the patient. More over, the contests take place when this inexperienced player is most vulnerable - when the patient is sick or injured.

To further compound the absurdity of this lop-sided contest, it is not the medical industry or the insurance provider who must bear the ultimate responsibility for the bill. The patient is legally and ultimately responsible for the cost of his or her care. While the insurance company denies claim after claim and the caregiver demands payment, the easy target, and the one the law requires to pay, is blindsided, often in no shape to offer any defense. In effect, the patient is steam-rolled into compliance by his or her own insurance company and by a caregiver who has nothing to lose by going after the defenseless, taking the path of least resistance, as it were. And neither the insurance company nor the doctor is going to go broke or have their credit ruined - that privilege belongs to the patient alone.

Any healthcare reform must address the dynamics of this paradigm. Somehow the patient, especially the one facing a medical catastrophe must be protected from losing everything because of an unwilling insurance company and an impatient provider. The patient should only have to worry about one thing - getting better.


kenju said...

AMEN! I don't know what the answer is - but you have hit this nail on the head!

~Easy said...

Yes! This was exactly my problem 2 years ago. Luckily, I had the means to make a few payments here and there to keep the wolves at bay, but it does suck. Excellent approach!

Maybe you should be Obama's running mate. ;-)

Snaggle Tooth said...

I remember you writing about this issue earlier, how true it resounds.
Best of luck securing on of these intensive pursuits.

Remember the economics and effects of the drug companies role also in this unfair pillow-fight.

gautami tripathy said...

I like the way you have written about it.

Michele sent me here.

barbie2be said...

wow, that's the first time i have seen anyone address the real problem. i've been in that exact position. it isn't fun.

michele sent me over today.

Wonelle said...

And if one is already low-income, aged and/or disabled the system is even worse.

Thanks for visiting. I don't get around to the keyboard for pleasure as much as work to the extent I'd like to...

Good luck on the fellowship position!

Anonymous said...

Blogger ate my comment, sorry about that.
Michele sent me to congratulate you on your very articulate description of they way the world works for the lower income brackets. I myself have no insurance, I could get it through my work but the basic (very poor-high deductible) insurance is $70. per pay period for me alone, if I add my kids it's over $150 a pay period. Therefore the kids are insured by their dad (Army insurance- Tricare) I don't go to the Doctors ever, I just try to eat well & stay as healthy as possible & I live in fear of getting into a car accident or some other situation where I have to go to the hospital.

Shephard said...

It's so obvious and clear when you outline the reality of healthcare. Why do they all try to complicate it?? (that's rhetorical, of course, because I know why).

Great post.
And I posted more squirrels on Thursday, btw. lol

~S :)

Shephard said...

Oops, Michele says hello!

Andi said... This is the beta-testing campaign....for coffee. I hope that you are able to get in. They want people to blog about the coffee after they taste it. Obviously, from my blog, I like coffee. :-)

rashbre said...

It seems despicable. The ability now of margin based businesses to slow down their administration at the expense of the people who pay fpr the service, not just in healthcare insurance is disgraceful.

You are right to flag healthcare, and another recent case is the delayed removal of patent from a well known drug, which has had many years of administrative braking applied preventing its more economic release after it was out of patent and the profit had been taken by the inventors.

As business expects its quartely returns and everything is racheted towards the fast buck and the shareholder return, there are aspects of morality and commonsense which seem to be left on the doorstep.

Champion your cause well.

regards, and those also from Michele! rashbre

craziequeen said...

Hi Mike, you seem to have capsulated the medical question in the US.

Here in the UK we still have the NHS (until some moron in the government administrates it to death) which cares for people on the state.

Michele sent me to say hello, and I was shocked when I read down about Jeff Healey. That man was gifted and SOOO nice....what a waste. But his years on this mortal plane gave us and his family a magical legacy.


awareness said...

You must have an indepth personal knowledge of this inhumane system from your own experiences after you car accident, Mike?

The last thing anyone should have to worrying about when a health catastrophe hits is level of care and whether or not it will completely annihilate them financially. As much as the system in Canada is a bureaucratic nightmare, and is abused by many who overuse it...... I thank God we have it. Not many here take it for granted after realizing that a country as rich as the USA doesn't look after their own in the same way.

Great piece.

Bobkat said...

Indeed, it should be the only thing the patient has to dela with and not have to worry about at all! Unfortunately, I cna tell you that this isn't even the case when the state provides the healthcare as there are often differences in the level and standard of care you receive dependant on your address, and even then, you are unable to get the really expensive care, the new drugs, the ones that could make a difference when nothing else has. Then you are left having to find the cash from somewhere with no insurance to help or go without. I am not sure what the answer is.

Best of luck with your application though. You raise some great points so I hope they listen.

Michele sent me by which is great as I have been away with study and work lately and so needed to catch up with my blog friends.

Sleepypete said...

As everyone else has said and I agree - spot on.

All the patient will be interested in is getting better and they'll usually be in such a panic over their continued existence that they'll say "ok" to anything that may get them back to health.

Which means they get caught in the trap of the hospital wanting payment and the insurance company saying "was that really necessary?"

A UK person (me!) could say "at least we have the NHS" but reading any story about NHS waiting lists will tell you that we have a 2 Tier system here - the Private sector for those who are happy to pay and the underfunded NHS for everyone else.

Michele sent me to wish you good health :-)