"Treat it like car insurance ."

In almost every cry for "nationalized healthcare" these days, there seem to be one of two basic mindsets advanced for such a program. One camp continues to advocate the "Medicare model," seeking to base an expansion of health insurance on this overblown and bloated methodology, which is already very near the point of bankruptcy or drastic cutback on services in order to continue to function at all. Enough has been said, both here and elsewhere, about how absurd this system is as prototype for broader "coverage."

However, even among those who recognize the serious faults in the present Medicare model, there are many who see health insurance as just another mismanaged program, which if only it were better regulated would answer all the problems it now presents. These folks point to the "automobile insurance" paradigm as something the healthcare industry should emulate. They also use the fact that mandatory auto insurance has become the rule rather than the exception, to indicate how easily health mandates could be applied across the board.

What they fail to consider is how different insuring an automobile is from the personal health and wellness realm. Herewith is an attempt to define some of those differences.

First, let's examine the "mandatory" aspects of auto insurance. Even in its most draconian implementations, this does not compel drivers to take on full coverage (including comprehensive/collision, maximum personal injury, car rental during a disabled vehicle, etc.). It only requires the driver to be insured for liability to others, at least to a minimum standard of coverage. The focus of the mandates is on your burden on innocent others, not on your personal well-being.

Second, the incidents covered by an auto insurance policy are restricted to the results of accidents and breakdowns, even under the most all-inclusive policies. There's no coverage for routine maintenance, oil changes, parts or labor for repairs, etc. All of this must be secured under a separate set of warranty coverage, none of which is mandatory in any state - nor is it likely to become so.

And finally, car insurance may currently be obtained through a much wider variety of insurance agents and companies, in many cases spanning state lines and boundaries. Although the rates themselves may be based on where you live and the actuarial statistics pertaining to that area, in most cases companies based far across the country can serve your requirements, competing with localized agencies.

Now compare all this with the health insurance model, if it mimicked the automotive one. If the only requirement was that you minimize your negative effects on others, a proper mandate might require you to avoid contact with others while afflicted with a communicable disease. During flu season, for example, one might wish to secure some policy that paid at least partial wages for time missed while staying home and recovering from a virus, rather than passing it to others by our presence in the workplace. No other coverage (except perhaps for the medicine to speed recovery?) would be then deemed mandatory, although one would be responsible for remaining isolated until the ailment had passed, at least through its communicable stages.

The limitations on personal-care coverage, even as voluntarily incurred, would also be pretty restrictive if we strictly adhered to the automotive model. Just for starters, physical exams, screenings and other supposedly "preventative" actions would not be covered by the policy; we don't object to paying out of pocket for an oil-change, or a new battery - or if we do, we've secured a repair and maintenance contract to limit those expenses beyond a certain level. (Note that one can now do something similar with healthcare, by taking out a high-deductible, catastrophic-only policy, with low premiums, while investing the remainder in a Health Savings Account to pay for those "maintenance" costs.)

Whatever the case, under this paradigm there would be no need for the massive amount of paperwork and bureaucracy we now must weather - in every doctor's office, clinic and hospital - processing all those claims and forms for routine examinations, screenings and treatments, for the mere security of detecting possible serious ailments before they become inoperable or incurable. Paying up front and at point of service would cut such administrative costs considerably, and any healer who failed to pass along those savings, with lowered fees, would not stay in business very long.

Only the big-ticket items, caused by "collisions" with other elements (in this case, chronic diseases, accidents and other catastrophic events, comparable to "other vehicles, physical barriers and tree-trunks," in the case of the autos), would be "covered" by insurance under such policies. If we chose to add "coverage" for either minor ("fender-bender"?) or health-maintenance events, we could do so, but this would not be mandatory under a consistent application of this paradigm.

Finally, if we were truly basing this process on the automotive model, we'd be offering a lot more options, and without the state-line boundaries that now exist. While some leeway among local providers does exist, there are so many mandated coverage provisions imposed by individual states, with no recourse to avoiding them in being "covered" within that state, that the cost of the policy is artificially increased just by that factor alone. Bottom line, the "car insurance model" might be a good starting point for serious healthcare reform . but only if one really means what is implied by that idea.

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Australia: Woman's death in government hospital was preventable

A MELBOURNE woman who died after giving birth could have survived if her medical treatment had been more timely and organised, a coroner found today. Piyanat Siriwan, 33, died at 2.15pm on April 1, 2004, at the Monash Medical Centre from massive blood loss after giving birth to a healthy baby girl at 8am that morning at the South Eastern Private Hospital in Melbourne's outer east.

Delivering her finding today into the death, Coroner Paresa Spanos said with more competent medical management, including a more timely transfer from the South Eastern Private Hospital, Mrs Siriwan "had a reasonable chance of surviving''. "In that sense I find her death was preventable,'' Ms Spanos said. Saying Mrs Siriwan's transfer between the hospitals was "a study in chaos'', Ms Spanos was critical of Mrs Siriwan's obstetrician Maurice Lichter and anaesthetist Emlyn Williams in their handling of her case on the day of her death, and ordered them to front the Medical Practitioners Board of Victoria (MPBV). She recommended the MPBV take whatever "action it deems appropriate against the two doctors''.

Ms Spanos also made an adverse comment about South Eastern Private Hospital not having made Dr Lichter or Dr Williams aware there was an emergency supply of blood available which would have been used to help Mrs Siriwan. She recommended the hospital ensure all doctors were aware of such supplies being available in future cases.

However, Ms Spanos said she did not have any adverse comment to make in relation to the Metropolitan Ambulance Service or the nurses attending Mrs Siriwan on the day, adding that their concern and frustration had been evident. A lawyer for Mrs Siriwan's husband, Harrinat Siriwan, said outside the court that he was too upset on hearing his wife's death was preventable to speak publicly.

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