Okay, I’m just gonna have to go all Doctor on you now – health care reform

I posted this article about three years ago in the heat of the health care reform debate. I thought that I would post it again. On the Last Word, they talked about how we got here.

This is what I wrote a couple of years ago (psst… we need a single-payer system):

I’ve talked about health care reform over and over again (I don’t see how Joan does it every day without going insane). I’ve talked about healthcare from an emotional standpoint and from an American legislative standpoint. I’ve talked about all the benefits of health care reform. Well, I’d like to take a different tactic. I would like to review the medical literature. I’ve picked several studies which I will describe over the next several days. The one thing that all of these studies have in common is that they point out that health insurance is a predictor of outcome. On Wednesday or Thursday, I’m going to review an article from the Journal of the American Medical Association which clearly states that having a unified health program has survival benefits. (We don’t have a coordinated, organized healthcare system in the United States.)

As a trauma surgeon, I don’t like to talk “shop” with people who are not in the medical profession. As soon as you start mentioning cytokines and mitochondria DNA, most people’s eyes glaze over. But, with watered-down legislation creeping through the Senate at a glacial pace, I thought it was important for me to go over some of this literature. The literature makes approximately the same point that Keith Olbermann made about a month go when he talked about having health insurance being life-and-death.

In trauma, we, trauma folks, would like to think that we treat patients all the same. Many states have trauma systems in which an injured patient, is shunted away from small hospitals that probably cannot help that patient and toward trauma centers who have the expertise and the manpower to help. This move has been shown to save lives. Most, if not all, trauma centers have protocols which are then individualized for a particular patient. We have found through numerous studies that these protocols help save lives. Therefore, you would figure that the outcome for a patient who was seriously injured in a car crash would be directly related to his or her injuries. This is true, for the most part. A recent study, however, has thrown a wrench in this.

A study, published in The Archives of Surgery in 2008, investigated over 400,000 patients who had been entered into the National Trauma Databank. One thing that we have known for years is that socioeconomic status does influence your outcome. As expected, mortality rates for Black and Hispanic patients were higher than those of White patients. Patients with insurance had a mortality rate of approximately half of those without insurance. Now, for the shocker — both Blacks and Hispanics with insurance who were injured had a mortality rate less than Whites without insurance.

This was a very surprising result. Numerous studies in trauma patients over the years have shown differences in outcomes among the races. As more and more studies have been done, it is clear that race is a surrogate for multiple other factors, including eating habits, living conditions and other things that can affect outcome. It is also clear that insurance acts as a surrogate for those same kind of factors. People with insurance have jobs. People with jobs drink less than people without jobs. People with jobs tend to live in better conditions than people without jobs. What was surprising is how strong insurance is as an indicator of lifestyle.

So, if every American had health care coverage, would they all have better outcomes from trauma? Well, this question is somewhat hard to answer. On one hand, just having insurance does not get you to live in a better house, in a better neighborhood with better indoor plumbing and a refrigerator that works all the time. On the other hand, one of the huge problems that we have in the trauma community is that we have to send many people home from the hospital after their hospital stay is officially over, when they should go to a rehabilitation center for more therapy. So many cannot qualify because they don’t have insurance. These patients would instantly do better. Getting adequate health care coverage to all Americans is a step towards better equality.

I would like all members of Congress to read this article. This is important. This is what we’re fighting for. We’re fighting for a more equitable society. I’m not trying to take away any healthcare from anybody; instead, I want to add healthcare to those who don’t have it.

Tomorrow, I’m going to review an article called Health Insurance and Mortality in United States adults. This article expands on the concept that insurance is a marker for outcome.

13 Responses

  1. Dr Thompson,

    I think nearly everyone agrees that increasing insurance coverage is a worthy and necessary goal (well, except those who want to destroy insurance companies altogether and have the government ‘play insurance company’ for us all), the question is how to achieve it?

    Fines and threats of prison for not enrolling (the current Democratic approach) are a bad idea, IMHBDAO.

  2. So, how would you do it? How would you get everyone covered?

    BTW, what value does the insurance company add to healthcare?

  3. Thanks Erri!

    Now that I’m working in a hospital again, I see daily how decisions get made based on coverage rather than medical necessity. It’s a disgrace!! 

    I keep wondering who started the idea of “health insurance”? Insurance is basically legalized gambling. The whole point of most insurance is that I pay a small amount monthly in hopes of averting a larger amount later.  The company wins when I DON”T use the benefit.  Very backwards!

  4. Kathy —

    Thanks for your thoughtful comments. I truly appreciate them.

    As I understand it, health insurance grew out of World War II. During the war, we had wage price freezes. Employers had to come up with new ways to attract employees. Health insurance was born. It is simply grown from there.

    Thanks again.

  5. ‘What value does the insurance company add?’ is of course the wrong question.

    ‘What role does the insurance company play?’ would be better.

    The insurance company provides the financial instrument for people to access care that they otherwise wouldn’t be able to afford.

    If you want to compare insurance vs. government as a non-value adding middleman, lets go at it.

    Government has a long track record of bloated inefficient bureaucracies. Do you really want a health care system modeled after the DMV and the IRS?

    Not everyone will buy insurance. And not everyone thinks they need to. It should be up to the individual how he chooses to pay his bills.

    Young healthy people who face little risk of getting sick often choose not to insure. Some of them will lose that financial bet. Most of them will win it.

    Those who end up paying large out of pocket bills will have to pay them.

    The key to enabling MOST people to insure is to make it affordable.

    –Allow individuals to band together in large groups (without being an employment based group) to purchase group coverage and negotiate favorable rates like large corporations and unions do.

    –End cost-shifting. People with private coverage should not have to pay what others refuse to pay.

    –End the exemption for ‘self insured’ plans. If an employer wants to ‘play insurance company’ , he should be regulated like one.

    –End illegal immigration. Non-paying criminals are bankrupting the system in several states.

    –Allow everyone to have an HSA/MSA to cover deductibles and copays, thus encouraging the use of higher deductible, lower cost catastrophic coverage plans. First dollar plans are very expensive and largely unnecessary.

  6. Why don’t you compare apples to apples? You are comparing health insurance to the government’s delivery of health insurance. It isn’t like we don’t have a model. it is the VA. The VA delivers great care for much less money than private insurance.

  7. And those who use the VA have a choice whether to use it or not.

    If single payer fans get their way, there will be no choice. No options. No escape.

    Why do you wish to remove American’s choices from them?

    If YOU want government care, then by all means join the military and utilize the VA. That’s YOUR choice.

    Surveys show that an overwhelming number (over 80%) of Americans want to keep the insurance coverage they have chosen.

    Americans are sympathetic, so they support the idea of ‘reform’ to the extent that they think it may help OTHERS.

    But they want to keep their own coverage that they currently have.

    Why is it that liberals are all ‘pro-choice’ when it comes to abortion, and anti-choice when it comes to every other medical procedure? Liberals are all ‘get your laws off my body’ when discussing abortion, but ‘put your laws all over my body, AND MY NEIGHBOR’S TOO’ when it comes to every other medical procedure. What’s going on with liberals these days?

    What ever happened to those liberals that didn’t want the government in between a patient and a doctor?

    And make no mistake, if the government holds the purse strings they will ALWAYS be in between a patient and a doctor.

    Plus, do you really want members of Congress handing out medical equipment and funding for specialists like they do roads and bridges, Dr Thompson? Do you really think that is in the best interests of your patients?

  8. The insurance companies should be destroyed. Joe White is just repeating all the right wing lies. Go to hell you goddam shill!

  9. Joe White: In the words of the eponymous Joe Wilson “you lie”. Instead of hypothesizing the consequences of single-payer, you would be better off to actually look at existing single-payer systems. Canadians and Americans are similar, except that Canadians are significantly more civilized. Our single-payer system works well and I have never noticed the government standing between me and my doctor.

    The facts contradict your hypothesis; if you are a rational person you are left with no choice but to admit that your hypothesis is wrong. 

  10. Canadian —

    Thank you for your thoughtful comments.

    I think you’ve hit the nail on the head. This is not about a rational discussion. It is about an irrational fear of too much “big government” or about insurance companies losing income. This debate is about money in the hands of big business.

    Thanks again for your thoughts.

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ABOUT AUTHOR
Errington C. Thompson, MD

Dr. Thompson is a surgeon, scholar, full-time sports fan and part-time political activist. He is active in a number of community projects and initiatives. Through medicine, he strives to improve the physical health of all he treats.

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A Letter to America

The Thirteeneth Juror

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