Monday, September 14, 2009

Everyday Life: If Only a Visit to the Doctor Could Be Like a Trip to the DMV

Throughout the summer, I heard a lot in the discourse claiming that if the US went to a universal, single payer health care system, with the suspected transitioning being via the controversial "public option," well, the experience would be negative, tantamount to going to the DMV.
Mid September, I made my first trip to the DMV since I reverted to my maiden name in February 2002. A month early, and because I was required to take a vision exam, I suspect because I am about to turn 55. I chose the Springfield (Virginia) Mall location for its proximity to one other errand I needed to run, and because it, and I, are close to exits off Interstate 395. When I arrived at 10AM, the doors had just opened and the line was halfway to the "Entrance 3" door, roughly 75-100 people. Nevertheless, people seemed to be filing through rather quickly. A half an hour later, I was at the Information Desk at the DMV doorway being assigned "A007." I had literally barely sat down and begun to fill out the paperwork that had been mailed to me that I had brought along to help pass the time before I was called. I completed the page at the window, sailed through the eye exam, smiled for the camera, and was through the exit door in less than 10 minutes. It was obvious that there was a system in place designed to prioritize transactions that were simple and needed little time, while allowing more complex ones additional attention. I was impressed with the efficiency and found nothing to gripe about. The medical parallel would be the difference between a routine or yearly office visit and an extended, urgent or initial one. I've sat in doctor's offices longer...with an appointment...most likely because of the variations in what the physician is presented with on any given day, crammed into virtually identical time slots. So the first positive lesson to be taken from the DMV for our health care system would be to differentiate a bit more based on need when scheduling time. Another one would be not to make an assumption based on anticipation of lengthy queues, and to realize that looks can be deceiving. That our emergency rooms are overwhelmed by patients with no primary care and/or health insurance is reflective of the status quo under our current system; we can change that. Yes, I expected a long wait, so I brought my patience, and, in addition to the DMV form to fill out, a book. Turns out, I was wrong. Yes, I've heard a horror story or two, but honestly not that many, regarding problems in other countries that have socialized medicine. But that is not the way it would have to be in this country. So if national health care were to look like the DMV, in my opinion, maybe that's not so bad. Which leaves me wondering why so many are so tenacious in clinging to or insisting on remodeling a rickety, broken down system rather than exploring and designing a completely new one. Almost 700,000 just turned out in droves to take advantage of another government program to trade in "clunkers." The analogy to health care is obvious, so why the irrational resistance?
I do have one unrelated question. The purpose of my visit to the DMV was to get a new, "secure" Virginia driver's license. But when I asked, I was told that it was to be sent to my home address, first class, no signature required. Am I the only one who sees the illogic in that! I also have one related observation. 28 years ago, when I moved to this area after law school, Springfield Mall was a vibrant center of commerce. Aside from those lined up at the DMV, on this trip, the lack of bustle compared to 7 years ago was noticeable. Another disposable structure cast aside for something "hotter." If we can change "traditions" for "shopping," why can't we do it for health care? What's the diff? If, as it now appears, we relegate the "public option" to an oxymoron, a minuscule, impotent self funded alternative of last resort, it in essence becomes just another underwriter and the system will not be substantially transformed. Why the love affair with insurers, when they routinely either partially or totally rescind coverage, their gatekeeper, perilous in this economy, is a job, and lofty ideals aside, they're a business and will find the loopholes in any plan to continue to make money? Less than a year ago, we voted overwhelmingly for change? What gives?

Karen Ann DeLuca