Serious Healthcare Reform – Starting from Scratch

Posted on June 2nd, 2009 by ecthompson

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.

Tags: Healthcare // View Comments

  • Dr. Kirsch -

    thank you for your thoughtful and insightful words. As we can already see those who support single-payer and pushed to the back of the room as if single-payer is not a serious option. If we want single-payer and if we want to reform were to have to push Washington towards it. We are going to have to write letters and send faxes and e-mails in order to drown out the interests of those who have money and fear losing it.

    Thanks for the link.
  • Michael Kirsch, M.D.
    Dr. Thompson's approach to health care reform seems highly idealized. Everyone of his well intentioned recommendations would be attached by powerful stakeholders in the health care arena. What represents 'reform' to one constituency means loss of income and control to another medical special interest. Do we expect major players in the game to voluntarily surrender to serve the greater good? For more thoughts, see www.MDWhistleblower.blogspot.com
  • DRW
    We suffer from overuse of the medical care system. We cut open, replace, remove, medicate far more than we need. If you have elderly parents you'll understand this, because my grandmother was barely medicated and lived to 90, but my parents eat fifty pills a day and probably won't make 90. Why? Because once you live past 20 life expectancy has been constant for 50 years. So if all this health care isn't prolonging our lives it must be improving our quality right?

    Doctors are business men who now run corporations that are publiclly traded. When I was a child, hospitals were where you went to die or get operated on. They were non-profit entities run by mostly religous organizations. It is not hard to figure out what is wrong. We have two competing corporations driven by greed to make more and more money, niether is going to tighten their belts. The system is broken because people assume the doctor is right and we deserve the best care money can buy.

    We are fat, lazy bastards. We need to get healthy, and prevent half the costs this way. Second, we need to actually pay attention to what it costs. I just had two x-rays that five years ago cost $200. Today, they cost $2,300. Well I still only paid $200 because of my insurance. So I;'m left wondering... Does it just cost $200 and the $2,100 the profit the hospital, insurance company, and doctor split by ripping off my employer? Probably.
  • EP3
    I think what we are missing to answer some of these questions is the human factor, or the vanity factor. For example, you are the greatest doctor in the world. Would you treat some Joe Schmo who works at McDonalds then your next patient is President Obama? I say no. Through the insurance industry, doctors and rich people can determine who gets to see the best doctors. Again, the vanity we Americans especially have that individually we think we are better than each other. Alan Greenspan thinks he is better than the McDonalds worker so he doesn't want to share the waiting room with that worker. And doctors can pick and choose patients by accepting or rejecting different insurances. In this example, say an insurance policy only covers African-Americans. A doctor can reject that insurance and not be considered racist.
    Also, you hint at the time factor. A doctor can control how many patients he sees through what insurance he takes. If a doctor were forced to accept Medicare for all, he might have his office flooded with patients everyday who want to spend hours of his time talking about different issues they are having. With insurance, he is limited on the amount of time he spends with patients and by limiting the type of insurance, he can control the number of patients.
    But since the rich elite minority seem to set up every other system in our country to somehow benefit them, this would be a logical conclusion. Why wouldn't a doctor be happy to have to deal with only one insurer, i.e. Medicare? Because Medicare would limit what they could charge for services and force the doctor to take more patients to make up the difference.
    I also ask why is it that most universities and medical schools limit the number of students that can enter into their programs? I understand having high standards for applicants, but manipulation of the market is not capitalism.
    Please believe I don't think most doctors are like this. I believe our doctors are grossly underpaid when Bill Mcguire can make $1 billion dollars for denying people health care.
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