May 2020 The Adirondack Daily Enterprise

Local government revenues are way down due to the virus crisis. They need to save money, so why not implement managed care for emergency services?! It’ll work like this: Your car is on fire, so you call 911. Instead of a dispatcher, you get a case manager. It’s expensive to send the police, fire or EMS out for just anyone who calls. So we’ll incentivise the 911 case managers for containing responses. The best case manager at denying care gets a goodie … say, free Netflix!

To illustrate, here’s a case-managed 911 call:

“911, what’s your emergency?” (slight foreign accent)  “My car is on fire!”  “I’ll be happy to assist you with that, sir. Is this your only car?”  “Um, I have another car … at home.”

“A-ha Sir, we send the fire department for true emergencies only. You have another car, so you can afford to lose this one. Have a nice day!”

This continues. A house is robbed, but the police aren’t sent because the owners are fine — they can go to the police station and file a complaint. A man breaks his arm, but he can drive one-handed to the emergency room. Eventually we’ll need fewer fire trucks, stations, police cars and ambulances.

Sound insane? Well, that’s what we do today with health care. When we are sick, the doctor often has to coordinate treatment with the insurance company, whose employees are incentivised (with stock options, not Netflix!) to deny coverage. The documentary “Sicko” featured a child who was denied a cochlear implant in one ear because her other ear was fine. There are innumerable other tragic examples.

What if, instead of district taxes, we purchased emergency services insurance? We can privatise the whole system! Then a call to 911 would involve arguing with the insurance company representative prior to haggling with the 911 case manager.

“Please excuse our delay. … Sorry, sir, you don’t have fire department coverage in your location. Is your burning car drivable to the next county?”

The insurance industry massively profits under this scheme — that’s why our health care system is the most expensive, per patient, in the world. But their quest for cost reductions also drives consolidation. That’s why we have fewer beds and fewer hospitals than we used to. The consequences are especially acute today as our health care system struggles to treat COVID patients.

The obvious solution is to socialise health care, as every other advanced country does. Most of us take for granted that other emergency services (fire, police, EMS, 911) are socialised, and we’d never tolerate rationing their services via privatised, managed care. Isn’t our health as important as a burning car?

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