Saturday, December 19, 2009

Health Care Debate

As far as health care is concerned I am for some type of reform. I have had more refusals of care from private insurance companies over the years, than Medicare or even Medicaid. So I am for some type of public option. Several problems as I see it. The U.S. is rated 37 of the industrial countries as far as quality of health care. Every country ahead of us mandates more primary care. Less than 5% of U.S. graduates go into primary care now. Most of our applicants to our residency are foreign, mostly from India and Pakistan, and that is the same for most family medicine and internal medicine residencies. It also plays out in the number of doctors in the country. Most are in specialties. There is more prestige and most important of all more money. However, over 80% of all problems that walk into a doctor’s office can be taken care of by primary care. The specialists because they are specialists want and get more money for the same services as supplied by primary care. Next they tend to over use the technology which is very expensive and most of the time doesn’t need to be used. It is human to use it if it is available. It is also seen in the states. The upper Midwest states have the lowest cost and the highest quality of health care in the nation. However, Medicare and insurance reimbursement to those states is the lowest. Florida for example has the highest number of the specialists, fancy equipment, highest cost and lowest quality of care. Go figure. History has shown however, that any time some type of reform to cut back the cost of health care gets through the government, it is the upper Midwest states and primary care that is hit the hardest.

Next as far as the people are concerned, it is again human nature that rules. Want the best, but don’t want to pay for it and when recommended to do things that will definitely change quality and quantity of life, people do what feels good despite encouragement and evidence. It is a constant long term battle that ends up being very expensive. Example is smoking. We have seen a decrease in smoking and a decrease in the disease that it causes, but it has taken over 40 years to realize it. So I am afraid that the government will say that we must change people’s behavior, but again they will penalize the primary care docs if it isn’t done. Since it is prevention that primary care does primarily.

Next, malpractice. Yes Obama is a lawyer and such he will try to protect his own. But it is also known that docs win most of the malpractice cases brought against them. The problem is that you only have to win one or two to get wealthy. And in our system of malpractice the lawyers are awarded 1/3 of what ever they win. There is a clear incentive to file lawsuits. I like Nebraska system and it is the only one in the country. All putative damages go to the state general fund. The lawyers and the plaintiffs cannot get it. Reasoning is as follows; putative damages are meant to be punishment for the defendant, not a reward for the plaintiff or his lawyers. It actually makes sense and Nebraska has some of the lowest malpractice insurance fees in the country, because of it. No in Nebraska goes for putative damages in malpractice suites. The trial lawyers have been trying to get that changed for years, however. So I also think the legal system needs to be changed. That will be next to impossible however, because politicians for the most part are lawyers and lawyers will protect their own. They will use code words like fair, justice, etc. The real meaning is like specialist use against primary care docs, quality of care. There is no evidence for it; in fact the evidence is 180 degrees from what they say. The code is it is my turf and my money stay out. It is not for what is best for the patient. So much for altruism! Some may argue against me on this, but it is my opinion on the matter and I will not hide it. If we do not fix the problem the outcome will be less than desirable.

Skeptical DoDo

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