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On the Third Hand: Boss

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Steven Brill proposes in America’s Bitter Pill, a book about the U.S. health finance system, that the country should replace the current doctor-hospital-insurer system with a system in which hospitals would run health care delivery and finance organizations.

Brill says the hospital-led organizations should be responsible for competing with each other, improving the quality of care, and driving prices down.

The one obvious problem with that proposal is: Hospitals. Blech.

They’re great at providing care, but the ones I’ve been in have been the most horribly administered organizations in the United States. Doctors and hospitals may complain about health insurance company red tape, but I dare you to try to get a hospital billing worker on the phone to talk about a bill. I dare you. If you accept the dare: Bring a photograph of a loved one, so that you can look at it when you get angry and keep yourself from saying anything overly extreme.

Readers of LifeHealthPro.com might suggest putting health insurers or health insurance brokers in charge of a new breed of health care delivery entities.

The problem with trying to put health insurance companies in charge is that they have a political image issue. Even the Republicans beat up on them.

Health insurance brokers have proved in the past few years, beyond any doubt, that they’re the nimblest, smartest, most open players in the system, but you are a free and high-minded breed of people. If you tried to spend much time inside a 20,000-employee health care organization, how would you breathe?

So, how about the government? The problem there is: the start of the Patient Protection and Affordable Care Act (PPACA) exchange system. If Brill is to be believed, the divisions of the U.S. Department of Health and Human Services (HHS) couldn’t even be open and honest with each other when they were starting the exchange system, let alone with us people in the public.

Here’s the idea that came to mind: Put any big health care delivery entities in the hands of the retailers that have in-store clinics.

See also: In-store clinic growth continues

The clinics are cheap and efficient. The retailers that have them are big, reasonably well-run organizations that have their own, smoothly running Web stores. The companies have dealt with all manner of federal, state and local bureaucracy and set up great, standardized electronic health record systems.

And the chains with in-store clinics employ pharmacists. Pharmacists save about as many people’s lives as doctors and hospitals, without giving off the “How dare you question me? I save lives, bozos!” vibe that doctors and hospitals often give off.

On the one hand, executives at the chains with retail clinics are people, too. If they tried to take over the nation’s hospitals and group medical practices, the hospitals and group medical practices would probably try to cloud their brains with a blizzard of white papers.

On the other hand, maybe the chain stores could distract the health care providers by sending them to endless streams of presentations on the finer points of reaching the patient at the point of sale.

See also: Walmart adds patient care

On the third hand, if the country adopted this proposal, and something went really wrong, maybe we’d end up with a billing and reimbursement system that was almost as bad as it is now, but even worse, in some ways, because we’d all have to try to scan our own health care service purchases at a confusing self-service register that would get stuck and require us to call over a store employee, who would never actually be there. But at least we could skim the National Enquirer to keep our minds off of how irritated we were…