• Government run health care in Montana

    I can’t add much to this story at NPR:

    A year ago, Montana opened the nation’s first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition.

    A year later, the state says the clinic is already saving money.

    Pamela Weitz, a 61-year-old state library technician, was skeptical about the place at first.

    “I thought it was just the goofiest idea, but you know, it’s really good,” she says. In the last year, she’s been there for checkups, blood tests and flu shots. She doesn’t have to go; she still has her normal health insurance provided by the state. But at the clinic, she has no co-pays, no deductibles. It’s free.

    That’s the case for the Helena area’s 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor. Visitation is more than 75 percent higher than initial estimates.

    “For goodness sakes, of course the employees and the retirees like it, it’s free,” says Republican State Sen. Dave Lewis.

    For the record, Lewis was upset with the clinic when it was first opened. Now he “likes going there“. The clinic is saving the state $1.5 million because the care there costs less. Doctors aren’t fee-for-service reimbursed. Montana can buy supplies at lower prices. Visits are about half the price of what they would otherwise be.

    They recently opened a second such clinic in Billings. They’re planning more.

    It’s interesting to see this happen in a state like Montana. You’d expect them to hate government-run health care, and many of them did. But it turns out that the reality wasn’t so bad. I’m reminded of how everyone hated Medicare (until they didn’t). They hated government clinics (until they didn’t).

    They hate the ACA now. Will they always?


    • Interesting story. Despite the fact that there hasn’t been a formal study looking at long-term costs, etc., it seems pretty clear that the state is saving money. So why did the author include in the article–before the savings reveal–Sen. Lewis’ obviously misinformed opinions about what the clinic is costing the state? Seems like slavish adherence to he said-she said journalism.

    • It seems reasonable to me that government being such a big supplier of healthcare could hire its own doctors. They can then limit care to proven treatments and could perhaps save a lot of money. They could treat medicare and medicaid recipients along with gov. employees. They could also provide free public health items like vaccinations.

      The downside is that often Gov. programs work well for 5 or even 10 years but then the customer lock in and lack of fear of going out of business allows service to degrade even while expenses rise.

    • Everybody, and I mean EVERYBODY loves the government spending money on them. That includes everybody from liberal tax and spend democrats to so-called tea party “starve the beast” republicans.

      The difference between liberals and conservatives is this — liberals want the govt to spend money on EVERYONE, the conservatives are selfish and just want money spent on themselves.

      Ask yourselves this — when was the last time a social welfare spending program was repealed? Once you throw money at the public, they always come back for more.

      The general public will always vote themselves “bread and circuses”, even the conservative republicans do that (e.g. outrageous military spending, farm programs, etc)

    • Nice that the state can get its cost-per-service down, but that might not generalize. Taking down barriers to primary care does generalize. People who get good primary care get screened and counseled.

      Yes, making preventative care free is likely to save money. Yes, people are myopic about preventative care, that is why high deductible health plans generally except preventative services from the high deductible. When you have to pay the bill for the heart attacks, it saves money to screen everyone for high cholesterol and put lots of people on statins. It saves money to screen everyone for high blood pressure and put lots of people on diuretics (and more).

      The NPR story mentioned 600 cases of undiagnosed diabetes picked up. (No control, so we don’t know how many we might have expected, but let’s say a substantially smaller number.) Let us make an educated guess: Most of the 600 had multiple risk factors (age, weight etc.) Don’t they know this? No, they don’t. A goodly number had vague symptoms (thirst, frequent urination etc.). Don’t they know this? No, they don’t. People are myopic about preventative care. Knowing my risk for chronic disease is less important to me than knowing why MLB suspended Ryan Braun, though staying healthy is arguably more important to me. If you asked me, I would say it was, but I don’t act that way. We call that myopia.

      All the arguments for market-driven health care reform assume people are not myopic, but the evidence is overwhelming that they are. Mr. Lewis and the other Republican legislators in Montana may be learning this. We can wish the Republicans would learn more quickly.

    • How about opening it up to everyone in the State for free. Then lets see if we save money.

    • It is important to realize that the clinic is free for state employees and saves money compared to how much the state would have paid for their insurance if they would have gone to normal medical facilities.

      This is not a savings for everyone in that state and is not available to all people for free. All they did was set up their own provider who doesn’t bill outlandish rates like the insurance companies… If that is what the ACA / Obamacare was about then this would be a different discussion.

    • “They hate the ACA now. Will they always?”

      I sure do hope so. even with all the much ballyhooed “patient protections” and “consumer protections” it supposedly has, the aca is still very much a “your money or your life” extortion scheme.

      not to mention that people pretty much view the insurance companies as thieves and blood-sucking parasites and now the govt is going to force us to give them even more of our hard-earned money.

      of course people like free (or nearly free) health care. the whole reason we got medicare and medicaid in the first place is because the two populations most likely to (a) get expensively sick and (b) not have enough money to get expensively well are old people and poor people. not coincidentally, these are the 2 populations the insurance companies would not, and still will not, sell affordable insurance to.

      some anecdata for you… I live in a heavily tea-party-infused part of the country. we’re up to our ears here in people who live in mortal fear of “SOCIALIZED MEDICINE!1!!1ELEVENTY ONE!” but this is also florida and we get a lot of visitors from the colder realms – England, Norway, Sweden, Denmark, to name a few. when these visitors describe their health care experiences in their home countries, the tea partiers, to a person, all wonder “why can’t we do that? we need to do that here.” I always try to point out to them that that’s what socialized medicine really is. a few of them go quiet, and some even start to rethink their position, but an awful lot of them think i’m outright lying.