The Great Health Care debate

I feel like it has been impossible to blog...mainly because I have been in information overload.  So many things have been happening in the political sphere particularly as related to the health care debate that every time I sit down to write a blog entry there seem to be some major change that takes place before I can finish the post.  I mean we have had to deal with the "gang of six" in the senate and Baucus plan which in true compromise tradition made absolutely no one happy...the August town halls with people screaming nonsense at each other (my favorite stupid slogan..."keep the government out of my Medicare")..and politicians and talking heads on the right stoking up fear with worries about bogus "death panels" and fake claims about health care rationing (as if that isnt already a part of our health care system via HMOs and the current insurance industry bureacrats), and "Socialized medicine".   It is all pretty crazy and the din of opinions and the opinionated is truly frightening.  As the wide variety of health care plans snake their way through the political system I thought I would at least go on record with my thoughts...no matter how crazy the ultimate outcome is.

First as a disclaimer...I am a physican.  I did a lot of my medical training at a County based health system providing care for the indigent, and have worked both in a community setting in an urban area as well as for academic medical centers in a more corporate based entity.  In addition I did spend a little time working before medical school for a community health advocacy group for which health care reform was one of our primary activities.  I have had the opportunity to explore and experience many different facets of the medical system in this country and I can tell you without a shadow of a doubt....the view from up close aint pretty.  I have watched the system deny care and/or wait until people are catostrophically ill to give them coverage.  I have personally seen those struggling without health care wiped out financially because of an accident or unexpected illness.  I have had to fight with insurance companies to get the care my patients desperately need.

A few of my observations:

*  The United States does have one of the best medical systems in the country in terms of research, innovation and advanced technological care.....HOWEVER this is ONLY true and availible to you if you have a VERY good health insurance plan and/or a LOT of money!

*  there are approximately 37milion people in this country without health insurance...most of whom have jobs and are often in employment situations where there is no health insurance provided and they cannot afford it on their own...contrary to popular belief this is not primarily illegal immigrants

*  The insurance industry is a for profit business...that does NOT make any profit from treating/healing/curing any illness or even from providing health care to ill people. 

*  We are the only industrialzed, democratic nation in the world that does not insure that all our citizens have access to quality health care.

*  We have poorer health care statistics and indicators (on things like life expectancy and infant mortality)than many thrid world countries.

*  More than 50% of personal bankrupticies are related to health care expenses

Those observations are saddening. In a great country of plenty like ours,  it should make all of our citizens ashamed that these things are true.  It also saddens me that people in this country have taken the position that health care is a privledge that you have to earn...and not a basic human right.

People keep asking me what I think about many of the health care options that are out there.  Frankly they all have their flaws beacause they are linked to our current imperfect system  but if J9 ruled the world I would want to see the following things in a health care reform plan and have these ideas framed within the current debate:

1.  Health Care = Basic Human Right.  Period.
If we can just all start believing this, it would cause us to approach this whole debate from a different angle.  Right now as Americans we tend to view health care as something that is earned or deserved in exchange for you working a job.  Therefore it is easy for people with that view to resist any type of health care reform because they don't want someone else to have something that they work hard for.  They dont want to be seen as giving something to people who dont "deserve" it.  Everyone should have access to basic health care...not because we are trying to reward those who don't work but because having everyone at least have the opportunity to live a healthy life is the right thing to do, the morally imperative thing to do, the Christian thing to do.  Not only that but I think this fits squarely into our constitution's desire to "promote the general welfare" of our citizens.

2.  Universal Access to health care
Tied into #1.  I think ultimately we need a health care system that gives everyone access to a basic level of care.  Now this does not necessarily have to be done by a single-payer system (similar to Britian or Canada)...it can be a private (via our current employer based system and a supplemental free-market) public (via either expansion of current systems or creation of a new system) partnership.  If we are to increase our nation's health

3.  Emphasis on primary and preventive care
Our country does not have a "health" care system...we have a sick care system.   While we  pile money into the latest life saving pharmeceutical, traditional insurance companies have limited coverage for or rewards of initiatives to keep healthy.  Routine health care visits, obesity counseling (prevention and treatment), Exercise planning, complimentary and alternative medicine, stess relief measures and nutritional counseling and regulations should be a major force of any new plan if what we truly seek is to improve the health of all our citizens.  Particularly from the fiscal side for physicians we have to change how those activities are billed for and reimbursed.  Right now in the current fee-for service model you have more incentive to bill for procedures and technological interventions but little fiscal reward for the time spent counseling or working with a patient to improve their individual health status...that must change.  In addition we must create an environment where we make pusuing a career in primary care attractive to medical students (and yes part of that is making those careers more fiscally viable) and we need to increase the numbers of primary care providers so that we can actually provide basic care to everyone

4.  Malpractice/Tort reform
Right now because of the overly litiginous society we live in (apologies to all my lawyer friends) many doctors practice that lovely brand of medicine known as "CYA" (cover yo A$$).  Particularly in situations where there is no previous info on the patient (like in the ED or with patients who last went to the doctor over a decade ago because they have been without insurance) you feel you must pull out all the stops on the off chance that an outcome is less than favorable and the family sues you for all you have.  Couple that with the fact that the cost of malpractice insurance premiums grows far faster than inflation and that for many specialities (like OB/GYN) it is actually causing people to quit practicing medicine althogether.  We are now losing some of the best and brightest in the medical field because of their growing frustration with legal issues.  We need to have some independent review of medical lawsuits (which is present in some states) prior to them being brought forth (hopefully reducing the numbers of frivolous lawsuits) and look at some limits of jury awards.

5.  More focus on and support of medical/science education
It is pretty scary that the average amount of debt that medical students graduate with now is approaching $200,000.  Think about that it is like paying the mortgage on a house you will never live in.  It is no wonder that people tend to cluster in specialities where financial return is greatest and shun the lower paying primary care specialities.  There are some current programs that reward working in underserved areas but I believe we need to expand these programs.  The other thing that we need to focus on is early science education.  We are way behind the rest of the world in our children's skill and interest in science.  This is problematic because we are not appropiately replenishing the next generation of doctors, allied health professionals, researchers and scientists.  We have to make sure that we keep the pipeline full if we are to continue our spirit of innovation in our health care system.

Of course none of the current plans have all of these things....this is more like what my personal fantasy plan would contain.  But I do hope that ideas like this begin to be a part of the great health care debate and ultimately influency whatever plan comes out of Congress.  I personally feel that health care reform will ultimately be a stepwise process.  Much in the same way that theCivil Rights Movement went from Brown v. Board of Education in 1954 to the Voting Rights act of 1964...Health Care reform is likely to go that same route.  So here's hoping that the first steps that we are working on will provide the nidus for meaningful sweeping health care reform in the future.