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I have this recurring dream...


The day comes when our current healthcare system finally implodes... and by that, I mean really implodes, to where a huge block of people really could not get any care even dire circumstances... I would see it going down like this:

The army would draft us. It alone has the infrastructure to manage large groups of unwilling employees, knows how to run hospitals and clinics, and operate supply lines. It is good at triage.

Medical schools and training would be taken over. Medical education would be free. Specialty training would be based on 1)need, 2) ability, and 3) (last) preference. "Sorry, we don't need any more interventional cardiologists. You can have a general medical slot". Similarly, assignments would be based on need. "no, you don't get Manhattan; you are needed in Mason City, Iowa."

Care would be inconvenient, impersonal, cost-effective, totally science based, hateful and universally available. "No, you don't get proton beam therapy for your prostate.. Come back in 6 months for a repeat digital exam." "No, you don't get antibiotics for your sinusitis. Use nasal washes".

Physicians would be generously but not irrationally reimbursed. ( a quick aside; is there someone who is not somewhat offended by the fact that an interventional cardiologist at the 75th percentile of income makes $800,000 a year? Was medicine really supposed to be a pathway to great wealth, or were we supposed to do good work first and hope for a reasonable lifestyle?) Pay would be according to rank, maybe plus years of training. The colonel would get paid more than the Major because she is a colonel, not because she is a thoracic surgeon. At the top of the heap is some general who says "no" a lot when pressured by patients or politicians to make exceptions to care. He is outside the civilian judicial system.

Those of us who could retire or change jobs probably would, once our enlistment was up. Those who refused would be treated as deserters. There would be plenty of new applicants waiting to take our place.

I forsee that we will continue to try to keep the current system going with more and more patches and Bondo, until one day it just totally collapses, and not even the slightest vestige of care can be found. This might be our future.