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    Tuesday, December 27, 2005

    Sensible Proposition: The governor of Vermont has come up with an interesting proposal to increase health insurance coverage:

    The governor's proposal divides the roughly 60,000 uninsured Vermonters into three categories and calls for different strategies for each group:

    For the 45 percent of the uninsured who are potentially eligible for Medicaid, an effort would be made to enroll them into the program;

    For the 34 percent who do not qualify for Medicaid but have low or moderate incomes the state will provide financial help to buy insurance;

    For the 21 percent with incomes greater than 300 percent of the federal poverty level, efforts will be made to get them insurance but without any financial aid.

    The people enrolled in the basic insurance program will be rated differently than the rest of the state - meaning they won't have to compete against large employers and unions to try to get better insurance rates. He's also increasing the reimbursement rate for doctors under Medicaid so they'll be more willing to accept enrolled patients, and allowing individuals to buy insurance from companies in other states.

    Keep an eye on Vermont. This could turn out to be a workable model that the rest of us can use.

    Although I'm not sure I agree with this:

    I want every Vermonter to have a primary care physician, someone who coordinates his or her care. I really believe the basic reason, the most common reason, most people don't is they can't afford it,'' said Douglas.

    Many people don't have health insurance because they can't afford it, but there are also a lot of people who are young and healthy and never take the time to get aquainted with a doctor - because they don't see the need. Increasing the rate of health insurance coverage is good - but it won't necessarily translate into more people having a primary care doctor - at least among the healthy.

    posted by Sydney on 12/27/2005 07:57:00 AM 2 comments


    Knowing that this tends to make some folds a bit upset, I would also take issue with the idea that "all" patients need a primary care physician. There is precious little evidence that yearly physical exams for otherwise healthy young adults provides much other than cost for the system

    By Blogger Aggravated DocSurg, at 7:16 PM  

    You are right. A physical on a healthy young person provides a very low yield when it comes to benefits - with the exception of pap smears/pelvic exams in sexually active young women.

    That's why the primary care specialties now speak of the importance of a "medical home" - a doctor to call your own, who knows your history, and who can help you sort out problems as they arise. There's something to be said for that. You're more likely to get in for a sick appointment if you're an established patient, and it does help sometimes to have someone you know and trust on hand when things go bad.

    So, having a primary care doctor isn't completely worthless for the young and healthy. It's just not something that the young and healthy give much thought.

    By Blogger sydney, at 9:03 PM  

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