Sunday, August 9, 2009

Health Care Reform

What a hot button topic! First let me apologize for not posting for one week, I had to be gone on a family emergency. But this last week with the news items on TV have made me think. I agree the health care system in this country is broke. We are rated 37th of the industrialized nations in quality of our health care by WHO standards. But we are number one as far as cost. France has a hybrid system of government and private health care and is rated number one for quality. I found a hospital bill for my family member who had a routine (well relative routine) surgical procedure in 1968. The hospital bill was $850.00 for 1 week of care including surgery. The same procedures hospital bill would now be around $12,000.00. That is a increase in cost 14 times the original cost in 41 years. Of course those numbers do not reflect the surgeons fees.

The current projections put health costs in the near future at around 25% of GNP. Medicare and Medicaid are forcast to be broke in the near future. Who's fault is it? That is a complex issue. The simple answer is that it is everybodies, providers and consumers. First problem the doctors. Every nation better than us in quality mandates that at least half of their physicians be primary care. Today in the U.S. less than 10%, more like 8%, of graduating medical students choose primary care; Family Medicine, General Internal Medicine, and General Pediatrics. The cost of putting a student through medical school is so expensive that only the high paying specialities look at all doable. There is also a prejudice against primary care by specialists. When specialists see patients they demand specialist fees. When a specialist sees a patient that has a problem in an area he doesn't cover, he or she refers to another specialist. Result more expensive health care. 80-90% of all health care needs can be provided by a primary care specialist. People also demand to see specialists, when a primary care would suffice. This is part of the larger problem with the consumer in the U.S. they demand the best no matter what the cost, as long as they do not have to pay for it out of pocket. Hence doctors now rely more on technology than simple listening, observation,touch and thinking.

Next, the hospitals have to pay for expensive personel, like nurses, techs etc. The cost of the equipment is not cheap either. A CT scan costs around $300 v $1000 for an MRI and may give the same information. Next, the hospitals, not to mention the doctors offices themselves, have to have an army of specialists just to do the billing and filing insurance claims, including medicare and medicaid. Then the salaries paid to the hospital CEOs and CFOs are tremendous now. The hospitals have to make some profit, even if they are non profit, to build money to update equipment and to cover expense of bills not being paid by people who just cannot pay for the health care. Remember there is 50 million uninsured people in this country. That is more than the entire population of Canada. Next, the insurance companies themselves are for profit and pay their execs huge salaries. I know the job of an exec is tough, but it isn't that tough. I have insurance companies deny referrals or tests because they didn't want to pay for them. I have never had that problem with medicare. Remember everybody gets his cut as the patient goes from diagnosis to treatment.

Next, the pharmaceutical companies have been producing more expensive drugs, often when other older drugs will do the same job with the same side effect profile as the newer one. But they also have to satisfy their investors who demand profits. They also say it is for R & D. Some does go there and it takes a long time to get a drug to market or a medical device for that matter. A lot of drugs and device are developed at research centers and the companies then take on the job of manufactoring.

Part of this problem is the cost of liability, paying the lawyers. Most law suites are actually won by the docs and companies. But the legal system has a conflict of interest. They get a 1/3 of all winnings. So they don't have to win very many to do really good. I have an answer for them. Pay the lawyers like doctors. Make punitive damages payable to the state general fund. It is after all a punishment and should not be a reward to the lawyers and plantifs. This would be hard to get through state legislatures because they are controled by lawyers. Again self interest.

Now alternative medicine is not the answer. They are against big pharma, but big pharma has a set of criteria for effectiveness and safety that has to be met before their products are allowed on the market. Alternative medicine doesn't. And they realy want to sell their wares to the public without regulation as their products will not stand up to scientific scrutiny. I do not support in any way the paying of alternative health care treatments at all, despite what Sen Harkin says.

Last, the people themselves want the best, not pay for it. Or want frugal care for others, but the best for themselves. They want it yesterday. They will also try to play the system. Example of why we have DRGs now is when I was first in practice, it wasn't uncommon to see Jim and Betty Lou bring grandma into the hospital for us to baby sit while they went on vacation for two weeks. Lastly our life styles are not really conducive to good health or prevention. This is the fault of 5th Ave. It is also human nature. So any system will have to take into account human nature.
Skeptical DoDo

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