Health Care Crisis Worsens

Now that I have begun I feel a need to continue exploring health care reform in this blog. Truthfully I was disappointed at the minimal response I received from my last blog. In fact, all of the comments were positive, but there were so few people who bothered to write. I would think that the welfare of each of us and our families would receive a higher priority and more enthusiasm in our thinking. I received the following comment from a friend who is an expert in health care. He wrote: “Now for the blog......you have too much knowledge. It is clear that health care reform will be a major issue next year and if legislation is actually passed it will be written and voted on by people who have a limited understanding of the structure of the system. Not only is the health care system broken, the system we will use to fix it is also broken. I hope the new system, whatever it is, will provide realistic, affordable, universal high quality care, but I wouldn’t bet on it.”

It seems most of us only care about the cost of health care and not the delivery system. In other words, if I have my insurance and it doesn’t cost too much I am satisfied. The malpractice crisis is OK because maybe I will get lucky someday and I will be able to win a jackpot settlement against a doctor. And besides, in the meantime I can keep complaining that my doctor missed the correct diagnosis or my doctor didn’t get a good result from surgery. And look at the wicked pharmaceutical industry. They make so much money. It isn’t my responsibility to reform the health care system. They should do it for me. Sort of like the oil industry, I guess. Let the poor continue to use an emergency room instead of a primary care doctor for their needs. I only get upset when I have to go to the emergency room and the wait is 6-12 hours. Gosh darn it (thanks Sara) we can improve the health care system by putting more money in the pot as with tax rebates or preventive medicine and maybe a small increase in the taxes on small business.

Let me tell you about the health care system in the United States. Hospital professionals are uninspired and check the clock to see what time they get off work. Nurses are now administrators. Please don’t ask them to treat a patient. Primary care is offered by nurse practitioners with a master’s degree post nurses training or by physician assistants with up to 2 years training post bachelor’s degree. Doctors are depressed over increased expectations and decreasing pay and the ever present threat of a law suit. Small business is cutting back on health insurance plans because they are implicitly unaffordable. 47 million people are uninsured and that number is growing. I feel like the man in the cave in Plato’s Republic. No one seems to care that his reality is at best a reflection of something that is going on around him. And I am sure that if my readers and my patients who are affluent and educated do not wish to respond to this crisis, then it is preposterous that our politicians will do so.
Edward Lack MD http://www.metropolitanmds.com/

How about a health care plan that would work

I have been having a brain cramp for the past 2 weeks and have not completed my blog assignment. I seem to be transfixed on the coming elections and the incredible mismanagement of our fiscal system. I have wanted to blog about the candidates, but my past public relations manager and my current manager (can you spell "WIFE") have cautioned against it. They feel a health blog is not an appropriate place for political views. I can see their point. With so much vacillation on the part of the candidates and specifically a lack of candor, not to mention a candidate from "Call of the Wild" why speculate on what these people would do if they were actually in office. Could it be worse than Georgie-boy? You betcha! So I found myself between a rock and a hard place until I remembered I could talk about the candidate's health care plans and I might escape criticism for insinuating politics into a health blog.

First of all, let it be noted that the Harvard School of Economics tackled this problem around 1980 and concluded that if we moved health care insurance out of the hands of the employer and into the hands of the consumer, the relentless spiral in health costs might be controlled. Witness auto insurance in the hands of the consumer. Second, if lawyers did not dominate politics and the judiciary we wouldn't have a tort system that skews to the minority at the expense of the majority (please, no wounded responses from wealthy lawyers who might be reading this blog - you are part of the minority).

Third, there are very successful health care programs already operating in France, Denmark, and Taiwan and any of the 3 could be copied in this country with great success. National health care is essential to any efficiently functioning health system- but at a base level. That means senior citizens who have brown spots on their bodies will have to live with them or pay up. Brown spots are neither terminal diseases nor do they vitiate the effects of Viagra. Live with them or eliminate them but don't burden society with your aesthetic concerns! And while we are at it how much heart and kidney surgery is warranted after the age of 80 - Mickey Mantle anyone?

In all of the successful health care systems the individual decides how much additional insurance he wishes to buy and the level of service augments with increases in cost as it should in a capitalist society (OK Taiwan cheats, but the concept holds.)

So let's look at the proposals:

McCain is going to give us a $5000.00 tax credit toward buying health insurance and he will tax us on employer sponsored health care benefits. A basic health insurance plan for a family of 4 costs $12,000.00 per year!

Obama will mandate electronic medical records. The cost alone will bankrupt the system but not to worry. The paranoid in our society will challenge efficient transportation of medical records between health care sites. At present the only one's not allowed to know your records are your doctors. Certainly hospitals, their surrogates and the federal government have open access to your files. Then he is going to strengthen our current health care system, insure the 40 million currently uninsured and save us 2500.00 each. Didn't the Bush administration just get done telling us they would fix the financial crisis by working within the system?

Now here is a message to both candidates: the system is broken. You don't fix it by turning to the culprits who broke the system: hospital interests, lawyers, insurers, pharmaceuticals. You fix it by looking at other systems in the world that work. You fix it by trusting the public whose interests are in the health of their families as opposed to the industry surrogates whose interest is in their personal wealth.

In order to repair the system health insurance must be taken out of the hands of the employer. Second, a baseline system of health care must be available to all citizens. (It does not include kidney transplants, heart bypass surgery, and a lot of other things that are just too costly. If this sounds unfair, grow up and take some responsibility. If anyone thinks health care is a right, please take a look at the health care levels of the rest of the world.) The third part of the system involves a system of insurance with premiums that reflect levels of service and is coordinated with the basic government policy.

As Tom Lehrer said in the 60's: "Life is like a sewer. What you get out of it depends on what you put into it!."
Edward Lack MD www.metropolitanmds.com