When the world was young, life was simple. Marcus Welby was our prototype physician. He seemed to be wise, practical, compassionate and infinitely knowledgeable. He could handle everything from a splinter in your foot to ovarian cancer and he could fix an internal abdominal hemorrhage from a motor vehicle crash. Well, things have changed since then. We have CT scanners, which can give us a three-dimensional picture of a heart. Using a scope, we can remove a gallbladder with three small incisions that together add up to less than two inches.
Over the last 20 to 30 years, health care has become extremely expensive. Americans now spend over $2.1 trillion in health care, more than $7,000 per individual. We must remember that we are spending all this money and 46 million Americans are still not covered. It boggles the mind that we can spend such a huge amount of money and millions of Americans are not covered. It’s crazy.
Many polls have suggested that Americans want to change our healthcare system, but everyone seems to have trouble with the specifics. Let’s step back and start from scratch. What do we want from our healthcare system? It seems to me that a system that is cost-effective is crucial. An article in this month’s New Yorker reveals that in McAllen, Texas they are spending over $15,000 per resident and their healthcare is no better. The residents in McAllen are no healthier than the residents in Los Angeles or Detroit… or Asheville, for that matter. I think most Americans would agree that they want their insurance to travel with them, so portability is important. As we live longer and develop more and more medical diagnoses, Americans see more and more physicians. These physicians need to find a better way to communicate with each other in order to improve health care. We therefore need a system that is integrated. Patients should be able to choose their own physicians and their own hospitals, so independence is required. This basic right should be preserved. We want the best. The medical profession needs to figure out what the best practices are and give incentives to physicians to deliver the “best” of medical care. Currently, most physicians’ offices are open from approximately nine in the morning until five in the evening. The majority of people work during that time frame. Americans should not have to take off from work in order to see their physicians. Physicians must be more accessible. There should be incentives to open early and stay open later. Group practices should be encouraged to be open Saturday and Sunday. When problems arise between a physician and a patient or the patient’s family, there should be a way to resolve these conflicts without going to court every single time. We definitely need improved conflict resolution. There should be a way to find problems long before they become lawsuits, a better way for the medical profession to police itself or to be policed. Finally, every American needs to be covered.
The plans that are bouncing around Washington right now are hybrids of private and public health care. They seem to be more complex, rather than less. Why does delivering health care have to be so complex? Why don’t we make it simpler instead of harder? The primary reason that we are all discussing health care is because the costs have become astronomical. Does insurance add value and decrease cost? I think the answer is no to both questions. A single-payer plan that negotiates drug costs and pays physicians and hospitals for keeping patients well would be the most cost-effective plan.
Finally, most plans being talked about today have some sort of “value added tax” in order to cover the 46 million Americans who are without insurance today. If we eliminate insurance from the basic plan (insurance adds approximately 30% to our healthcare costs) then we don’t need a “value added tax.” We already have enough money to cover everybody. There’s no extra expense. There’s no need for employers to be involved. Businesses would save money. This seems like a system in which business wins, the American people win and the health industry wins. Outstanding! Now that I’ve fixed health care, I can turn my attention back to Guantánamo Bay and what to do with the detainees.