America's favorite pastime has become speculation about this subject. Wish I had some special insight.
What I am convince of is the need for change. A story:
A client of mine named Ronald was rushed to one of our local hospitals with a severe bladder infection. Spent the night in ER and was transferred into ICU early the following morning where he had a heart event.
Kept in touch with the nursing staff, msw's and discharge planners throughout to make sure that I'd be ready for his discharge.
During his first day out of ICU, I get an urgent call saying that Ronald was being sent home within the hour. A hospital bed and wheelchair had been delivered. By the way, make sure that 24 hour in-home care is in place.
Drove (rapidly) to the hospital to find my client still in isolation, still considered septic. But Medicare was no longer paying for his stay.
Good news for Ronald, the presence of a loud advocate kept him in the care of the hospital until he could be moved to a rehab facility 4 days later. Medicare pays for rehab.
Our current healthcare system, if it is a system at all, has lost the will to care for patients. It has became a system of lists, checkoffs and tight dollars (and many, many layers of paperwork).
Healthcare reform holds promise because it will reward primary care physicians, reward institutions that provide quality care and because it imprints the medical arena with a goal, a philosophy. It hopes to provide payment for the healing process rather than a series of steps and procedures. It hopes to not send Ronald or Joyce or Amalia home too soon, where inadequate care and oversight condemn them to either a rapid return to the hospital or death.
Don the Trustee
When my mother passed very suddenly some 16 years ago, I worked as a trustee for the first time. Her trust contained walnut orchards, peach orchards and a small vineyard. One of the properties was within the sphere of influence of the adjacent city and I dove in with the neighbors and started working on annexation. Loved this work back then and still find it very satisfying today.