Available Care Act – Beyond “Coverage”

Much talk about insuring people for healthcare needs.  The giant bedpan in the room is availability.  What good is having Medicare, Medicaid, exchange plans, if you cannot find a doctor for hundreds of miles who will accept your provider’s coverage?  Just look.

The pundits talk about providing millions of people “access” to healthcare; however, they cannot explain why many of the “covered” still do what they did when they had no insurance, go the emergency room of the public hospital known to be the one that cannot turn them down.

Health insurers specify what they will cover and what the insured must pay, in terms of dollars and percentages.  What they do not spell out, is the amounts they are willing to pay the doctors and hospitals for various treatments.  The doctors and hospitals that are willing to accept the insurer’s terms are added to a “network.”  If the insured uses these doctors and hospitals, “in network,” the patient pays less; “out-of-network” providers, the insured pays much more.

Medicare, and the related private insurance plans are shunned by many healthcare providers because of the intense complexity of coding rules, poorer reimbursement rates, and 6-month slow-pay of claims.  I cannot blame them for wanting the easiest, most profitable patients, but look at what that does to retirees:  it shoves them into the offices of the newest, least experienced doctors, who do not have privileges at the best hospitals.

Another specious barrier doctors erect is “not accepting new patients.”  If that is true, why do they prominently promote their doctors, facilities, and services?  Why do they list the insurance plans they accept, on fancy websites?  What do they do when patients get well, move, change, outgrow their need, or die?  Who takes their places?  Are there waiting lists?  This policy seems wildly inconsistent, and dubious to me.

Today’s labyrinth of laws, maze of insurance coverages, intricacies of medical practice, incorporation of hospitals, vast array of medical devices, tests, and procedures, and incomprehensible myriads of drugs and medicines, are the starting point of future choices.  The concept of choosing your doctors, clinics, and hospitals still appeals to me.  If all health insurance policies must meet some minimum standards of coverage, why should health providers exclude any of them?

We have a historic opportunity to put features into the fabric of healthcare; the federal government has more incentives and flexibility to “get it right” as they formulate new laws.  Why not pass a new law called “The Available Care Act?”  If you accept anything except cash for medical services or goods, you accept the coverage of any patient who walks in your door.

 

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Children Threatened in Public School Classrooms – Federal Laws Deny Them Protection from Disruption

Civilized societies set behavioral norms, and prescribe consequences for violating those norms.  For example, it is not okay to harm another person without cause; it is not alright to harass someone, or “disturb the peace.”  Families can set broader boundaries inside their homes, but not in public.  However, sadly misguided federal laws and rules subject public school children and their teachers to violent, threatening, disturbing, unpredictable, disruptive behavior every day, in the name of “equal education.”  This violates common sense and the rights of the other children to a peaceful education.

In the so-called “real world” normal people do not put up with violent or disruptive people.  The disruptive person is usually fired from a job in a work environment, ejected or arrested in social or public environments.  Medical treatment is indicated, to the extent emotional disabilities or mental illness are involved; punishment and fines are indicated otherwise.  In other words, society separates or isolates disturbed citizens and insulates normal citizens from their disruptions.

I do not know any normal, emotionally healthy people who are made to endure the disturbances of disruptive adults.  Why do we subject our children and public school teachers to behavior normal society does not allow?  Most teachers are not trained psychologists, and none of the students are trained to accept and deal with such frightening, threatening behavior either.  Even if they were, there is no excuse for making public school so trying, and perhaps harmful.

 The current federal laws paint children with “disabilities” and public schools with a broad brush when they require inclusion and mainstreaming without stipulation.  Do they think normal classrooms are therapy for violent and disturbed students?  Do they think the distress and disruption help normal students learn?  Disturbed, violent, and disabled students need added, special resources and treatment that normal students do not.  Why subject the whole class to special efforts that scare them, delay normal learning and deny them the knowledge they are present to obtain?

Special needs children deserve to be taught the same knowledge as other kids.  Many special needs children are not disruptive.  However, their special needs may require different teaching approaches and intensive, trained, instruction to attain that knowledge.

The advocates of “mainstreaming” tout the marginal benefits to special needs students, but blithely avoid discussion of the serious detriment to “mainstream” students and the teachers that must cope with the stress and interference required to produce those benefits.  This attempt at social engineering is so obviously lame, it cannot stand a reality check.  Does anyone remember when even whispering in class, and passing notes were punishable infractions?  They were infractions because they distracted students and teachers from the purpose of the class.  Has this idea expired from political correctness?

If the needs of the few can be met without expense to the many, I say, so be it.  Find another way to fulfill the needs of violent, threatening, and disruptive students.