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Serious Healthcare Reform – Starting from Scratch

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.

By |2009-06-02T21:10:54-04:00June 2nd, 2009|Healthcare|Comments Off on Serious Healthcare Reform – Starting from Scratch

Natasha Richardson and head injuries

Natasha Richardson, the 45-year-old actress, died today of a head injury. My heart goes out to her family and loved ones.

We see this over and over again in my line of work. It is the suddenness of trauma. Just yesterday or just this morning… or only an hour ago, our loved one was fine and then something happens.

As a trauma surgeon, I have no comment on her initial care, her flight from Canada to New York or her care at a New York hospital. Most of those details have been kept from the press. I will make a few general comments on head injuries. First of all, head injuries are extremely difficult to take care of. In spite of advances in CT scanners, operative therapy and ICU care the mortality rate from head injuries remains high.  Currently, our therapy focuses on reducing damage that has already been done. Our therapy focuses on limiting the area of damaged tissue. As of now, we have no way of reversing damage that’s already been done.

Secondly, prognosis is extremely difficult in many of our cases. Invariably, a family looks at me or any of the other physicians taking care of the patient wanting to know how was their loved one is going to be?  Initially, with just a few exceptions, we have little or no idea. All we have is generalizations. In general, older people do worse than younger people. Patients on blood thinners will do significantly worse than those patients who were not on those medications. Now don’t get the impression that we don’t know anything. There are tons of studies which have enrolled thousands of patients, so we do know a lot. We are not, though, being asked about a large cohort of patients. Rather, we’re being asked about one specific patient. Translating studies to a specific patient can be difficult if not impossible.

Thirdly, head injuries are a leading cause of death in the United States.

Finally, the suddenness of trauma makes it difficult for everyone involved. When psychologists talk about life stressors, this is stress to the max. Again, my heart goes out to the family.

By |2009-03-18T22:54:21-04:00March 18th, 2009|Entertainment, Healthcare|Comments Off on Natasha Richardson and head injuries

The Economy, Capitalism and the Candidates

There’s been a lot of speculation on who Senator John McCain then Senator Barack Obama would choose as their running mates. Almost everyone with a computer has speculated on who could be a possible running mate. Thomas Friedman, from the New York Times, has thrown his hat into the ring. Friedman presents some good evidence to show that our economy is in significant trouble. I think anyone with a couple brain cells that are firing should be able to see the decline of the American economy. We manufacture almost nothing in this country anymore. Our banking industry is in shambles. The auto industry is hanging on by a thread. Heck, a German company has offered to buy Anheuser-Busch.

Somehow over the last 20 years, money and not value has become the goal. For example, we see these nebulous corporations buy up nursing homes. At first, you scratch your head. Then you see them operate. Like a spider who wraps his victim in silk before sucking out all of the nutrients, these human vampires remove all the value out of the nursing home. They sell off CT scanners and x-ray machines. They outsource x-rays. Residents who used to be able to get an x-ray within minutes now have to wait hours or days. All experienced nurses are either fired or pushed out. They’re replaced by a new registered nurses or even nurses aides. Telephones which used to be answered by a real person are now answered by a machine. (Press one if you want resident directory.) I’m sure there are some that look at this is change. I would argue that this is not change for the better. With this type of change only the moneymakers are happy. Everyone else loses out. This is what has been happening in our country with almost every industry.

This gives me an opportunity to insert a clip from the Bill Moyers Journal. This clip is from about six or eight months ago. Bill Moyers chats with Benjamin Barber. He is the author of a new book called Consumed. They discussed the problems with capitalism.

Back to my original subject, vice presidential candidates. Thomas Friedman has been wrong more times on the Iraq war that I’m sure either he or I want to count. I think he is correct about the economy but incorrect about the choice of running mates. He suspects that each candidate will choose an economic guru as his running mate. Although, the economy will continue to be an important subject in the selection I do not believe that the candidates will choose someone because of their economic expertise. (If they were to choose someone with economic expertise, Barack Obama would likely choose someone like Senator Chris Dodd. John McCain would probably to someone like former Massachusetts Governor Mitt Romney.) I still think that John McCain will try to someone who will excite the Republican base and who will appear more youthful. I believe that Barack Obama will choose someone who has foreign-policy and military expertise.

By |2008-06-29T23:33:39-04:00June 29th, 2008|Economy, Election 2008|Comments Off on The Economy, Capitalism and the Candidates
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