So, what are the goals of health care reform? Some believe that the goals are just to rearrange the deck chairs. In my mind, we’re sailing on the Titanic; therefore, rearranging the deck chairs is not going to fix the problem. Instead, I think we need to take this opportunity to perform a comprehensive overhaul of our health care system. We must remember that our system developed over the last 100 years. It has developed mostly as a hodgepodge. There hasn’t been one person or one group of people who sat down and thought about how health care will be delivered.
Let’s guarantee health care for all. In my mind, universal coverage is the only way to get this done. This does not mean that everybody deserves or should be covered for everything. Instead, I do believe that office visits and hospitalizations need to be covered. Preventive medicine needs to be covered along with mental health care. Physical therapy and occupational therapy, prescriptions and dental care all need to be covered.
There has to be some mechanism to control costs. We’ve seen over the years that without cost controls medical costs skyrocket. Does every hospital need the latest CT scanner ?
Americans should be able to choose their own physician and their own hospital. Also, Americans need better data on what they are choosing. How good is that hospital, really? That data should be readily available. If you’re going to a surgeon for a hernia repair, what is his/her rate of recurrence?
We need to fix the problem concerning access to health care. Many patients complain about being unable to see a physician. When most doctors offices are open from nine in the morning until four in the afternoon and most people work from 8:30 in the morning until 5:30 in the afternoon, no wonder there’s an access problem. We need clinics to be open earlier and stay open later. We need clinics open on the weekends.
Health care reform must include high-quality, coordinated health care. We have to have a mechanism to control medical errors. How do we decrease or eliminate hospital-acquired infections? How do we guarantee that we are not paying for procedures that have not been proven to be of benefit? These things need to be worked out in order to control costs. A patient who is in a car crash in northern Pennsylvania is currently without his medical records. His physicians are flying blind, as it were. We should be able to put a system in place where his physicians have timely access to his records even if he’s from southern Florida.
We have to do something about malpractice. There’s not a day that goes by that physicians don’t worry about malpractice. Many physicians practice defensive medicine, driving costs up and doesn’t necessarily add to the quality of medicine that they are delivering. We need to develop a malpractice system were patient grievances are compensated adequately and quickly. On the other hand, frivolous lawsuits also need to be handled with minimal costs to physicians, hospitals and insurance companies.
Finally, we have to fund the system in such a way that is fair to all Americans. Everyone should have to pay their fair share.
I believe that these are the correct goals for reforming our health care system. What are your thoughts?
I agree with you entirely, but your last section on fair funding is a bit scary. I calculated that we’d have to tax or bill every living person in the U.S. at least $7,000 a year to pay the annual health care tariff in America. There’s no way I can fork out that amount of money, nor do I imagine many who could. It’s at this point where the feds start thinking the R word–rationing–and that’s the scariest part of all.
Gary –
healthcare is already rationed. We don’t call it rationing but that’s what it is. Suppose you have insurance and you walk into your surgeon’s office and say I have some gallbladder pain. I would like for you to take out my gallbladder. The doctor would call your insurance company. He would tell them that you would like to have your gallbladder out and you have had no tests. They would say no. Claim denied. Isn’t that rationing. Or you have peptic ulcer disease and your doctor would like to treat you with Zantac. Your insurance says that they will pay for a generic and nothing else. Isn’t that rationing? So, embrace rationing. We are already doing that.
Finally, if we have one payor and we give people incentives to go to their primary care physician and we tax people for not going for their yearly screenings, we can save money. If we eliminate some of the administrative money that is sitting in insurance companies that can save up to a third of overall costs ($800 Billion).
Thanks for your thoughts.
I have to agree with you on one thing. If people were to have preventative care then there should some consequences for not. The reason dental insurance is so expensive is because people won’t go for their semi annual checkups and only go when there is a problem which then costs many times more. The same thing with health care if people would do the preventative care once a year and catch problems early. Wouldn’t the costs drop considerably.
M –
You are 100% correct.
thanks for your thoughts.
The reason that it costs $7,000 a year is because the doctors have had to build in the expense of all the bullshit overhead for getting the paperwork OKed by the insurance companies, when they deny benefits that your damn policy guarantees you. There are more staff hours spent doing paperwork in a doctor’s office than people’s hours doing health care. There is triival oversight on whether you’re being billed appropriately for what you’re getting, whether what you’re getting is appropriate for what ails you, and whether that care was actually delivered. It can all come down a hell of a lot if there is single payer care.
The real rationing is when someone needs some basic care or preventative care and they can not even see a Doctor because they have no insurance. Or there is the time the insurance company tells you that the last surgery made you hit your yearly or lifetime cap for coverage, complications be damned. You are already being rationed to death by the for-profit system even if you have some access to coverage.
Brantl –
You are correct. Administrative costs have skyrocketed for a number of reasons. Insurance paperwork and run around is just one.
Thanks for your comments.
Connecticut Man1 –
I’m going to have table this one for now because I’m getting on a plane but I should have an comment late this evening.
Thanks for your thoughts.
I don’t want the gov deciding what kind of healthcare plan is best for me or my family.
I look at the veteran’s hospitals and I see how the government runs those hospitals: slowly and poorly! Why would anybody want that kind of reform? Thanks, but no thanks!
Jess –
So you would rather your employer or your insurance company make the decision?
Dude, if you have seen VA hospitals then you know there are good VA’s and bad VA’s just like any other hospital. Some that deliver the best care in America. If you would like to opt out of the best care in America then I suggest that you try health care somewhere in South America.
Thanks for your comments.
Checkout this website for Physicians for a national healthcare policy http://www.pnhp.org/
They make a good case. They clearly explain the difference between (the dreaded) socialized medicine (the VA) and their proposal for single payer health care (France and others).
It always amuses me when people say they don’t want anyone controlling their health care. As if…
The highest paid CEO in the country in 2007 was the CEO of United Healthcare. He in part accomplished that by denying people health care which is what they thought they were paying for. Now that’s the guy I want controlling my medical care! Also, big bucks for Big Pharma–yay!!!
AlliB –
Thanks for the link and your thoughtful comments.
Real Healthcare Reform: Changing the Incentives and the Rules of the Game; Creating an Electronic Health Record for Every Citizen Who Wants One.
If you have the financial resources of Bill Gates or Warren Buffett you needn’t pay money to a health plan each month, since if you get sick or injured – even very seriously – you have more than enough money to pay all your medical bills yourself.
But those of us with significantly less financial resources must find some other means of dealing with the thousands or even hundreds of thousands of dollars or more of medical expenses that we might incur should a serious illness or injury be our fate.
Enter the concept of “health insurance”.
Large numbers of individuals and/or their employers pay some money each month into one or another big pot called a “health plan”. Those individuals who remain essentially very healthy for many years and then suddenly die or perhaps leave a particular health plan for some other reason – if they have put more money into the pot than was taken out to pay all their medical expenses – wind up helping to pay the medical bills of those members of the health plan who become seriously ill or injured and incur a lot of medical expenses.
Many members of health plans don’t seem to fully understand – or perhaps choose to forget – that if they become seriously ill or injured, for the most part their medical bills will be paid by the members of their health plan who have remained healthy. Some Americans believe that healthcare should become a “right” of every American citizen. If a nationalized single payer health plan were enacted, every American citizen – who for whatever reason became ill or injured and incurred significant medical expenses – would for the most part have his or her medical bills paid by all U.S. taxpayers.
For any health plan to work which has a large number of people pooling their money to essentially pay the medical bills of whichever members of the plan become seriously ill or injured, rules must be established as to when and how much money may be taken out of the pot e.g. “legitimate” doctor bills and hospital bills. Equally important is keeping track of the amount of money that is being put into the pot each month in premiums paid by health plan members or their employers. If too much is being paid out in expenses as compared with the amount being received in premiums, the pot will soon become empty and the health plan will go broke.
As previously mentioned, the monthly premiums paid by individuals or their employers go into a health plan’s big pot from which “covered” healthcare expenses are paid. But also from this pot are paid all the health plan’s administrative expenses including what may be big salaries and golden parachutes for CEO’s and other “healthcare executives” – individuals who may be paid to find technicalities of one sort or another in the health plan’s agreements so the health plan can deny or reduce payments, raise premiums, cancel insurance, or in one way or another minimize or exclude “bad risks” from the health plan. All such questionable business practices are done to enable the health plan to make a profit and remain in business.
Currently we are experiencing continual increases in healthcare costs that are unsustainable and which, if unchecked, will soon seriously threaten the future of the entire American economy. Healthcare costs must be controlled, but how? If a healthcare system made up of health plans is going to have a chance of meeting the needs of its health plan members and simultaneously be able to keep costs under control, something very critically important must first occur.
It turns out that a lot of illnesses and many injuries are actually preventable.
Although health promotion and disease and injury prevention receive fashionable and socially acceptable lip service, the fact is that most of the participants in what should be more appropriately called our “sickness and injury care system” actually have no significant financial incentive whatsoever to spend significant time and energy in genuinely promoting health and helping to prevent disease and injury.
Much to the contrary. Other than the actual members of a health plan – patients and potential patients – and their employers and perhaps the employees of some health plans, most participants in our sickness and injury care system – because of the way they are paid – have an enormous (if unspoken) financial incentive for massive amounts of disease and injury – much of which is preventable – to continue to occur in America. Strictly from a financial point of view, for those whose income comes solely from the treatment – not the prevention – of illness and injury, the more illness and injury, the better. And if the illness or injury is serious and requires perhaps many expensive tests, multiple surgical procedures, and other very complicated prolonged treatment in intensive care, so much the better; just as long as those unfortunate individuals who happen to be ill or injured are “covered” by “good insurance”, i.e. health plans that are reliable bill payers.
This is not to say that there are not some excellent very dedicated and hardworking doctors and other health professionals – although they are paid on a fee for service basis to care for illness and injury – who nevertheless attempt to essentially work themselves out of a job by making health promotion and disease and injury prevention a top priority with their patients.
It should also be recognized that some existing health plans – e.g. Kaiser and Group Health – combine insurance, doctors, and hospitals into a single entity in such a way that provides everyone – including all the health plan’s doctors – a real incentive to spend time and effort with patients on health promotion and disease and injury prevention as well as on early diagnosis and treatment.
But unfortunately the above examples represent only a small part of the current sickness and injury care system throughout America.
For the most part – because of the way they are compensated – the majority of doctors and other professional providers, acute care hospitals and long term care facilities, pharmaceutical manufactures and pharmacists, medical and surgical equipment manufacturers and personal injury and malpractice attorneys – among others – depend mightily on massive amounts of disease and injury occurring in America; and these participants in our sickness and injury care system would be significantly negatively impacted if a lot of the preventable illnesses and injuries were actually prevented. This must be changed.
Unless the incentives and rules are changed to give as many participants as possible a real financial stake in health promotion and disease and injury prevention, in early diagnosis and treatment, and in maximizing health and minimizing disease and injury, healthcare costs in America will never be brought under control. Making appropriate changes in the incentives and the rules of the game in this direction is the real task and challenge of “healthcare reform”.
What about financial incentives for individual health plan members? Should individuals receive a financial incentive to be healthy? It is well recognized that engaging in regular exercise, abstaining from tobacco, and eating moderately so as to maintain a reasonably normal body weight are all significant factors in helping to promote an individual’s health and wellness. These healthy behaviors can all be confirmed by simple tests in a doctor’s office. Why shouldn’t those individuals who practice these health promoting behaviors and comply with recommended immunization schedules and appropriate preventive screening examinations such as for colon cancer and breast cancer pay significantly less to their health plan each month than those who don’t?
To really reform healthcare we must find ways – through changes in incentives and the rules of the game – to actually prevent what is preventable, to maximize early diagnosis and treatment, and minimize disease and injury with all its cost. We must find ways for participants to be part of our “healthcare system” and not just a part of our “sickness and injury care system”.
Significant changes in the rules of the game for our legal system – tort reform – is also critically important so that the gaming of the system now being done by personal injury and malpractice attorneys and their clients can be ended and so that the exorbitant costs to physicians and other professionals for malpractice insurance can be dramatically reduced.
Truly transforming our “sickness and injury care system” into a “healthcare system” by making significant changes in the incentives and the rules of the game may seem to be a formidable task and one that probably has never really been done before on a large scale anywhere in the world. But it is a worthy task and a critically important task for the future of America and its people.
One important part of this process is developing the capability of creating an electronic health record for every American citizen who wants one. We need a standardized framework that will allow every American citizen to have an individual electronic health record – a computerized medical record – that can be accessed by all the doctors who care for a particular individual, regardless of wherever on the planet the doctors or the patients happen to be. It would be like having your own personal online banking account that only you have the password to, but which you can share with the doctors who are caring for you, wherever you or they may be.
I strongly applaud those who are using their energy and expertise to upgrade our deplorable current paper medical records system and bring medical records in America into the 21st century. Developing a standardized framework for an electronic health record – for every citizen who wants one – created by your doctor with your assistance, which has proper security and safeguards is something that our national government can and should do as a part of healthcare reform.
If done well, electronic health records will be transformational in helping doctors efficiently and effectively care for patients and will save an enormous amount of time, effort, and money which is currently wasted on needless and frequently inaccurate duplication. Also, electronic health records will make it easier for an individual and his or her doctors to make a thorough assessment concerning appropriate health promotion and disease and injury prevention. Like the telephone and the computer, someday we will all wonder how we ever got along without electronic health records.
But we need action, not just words. Now is the time for Americans and their leaders and doctors to step up to the plate and begin the process of transforming our “American Sickness and Injury Care System” into an “American Healthcare System” that is worthy of our great country.
Robert Westafer M.D.