More than 30 consumers and health care professionals gathered last week to tackle a daunting question: What is the biggest problem with the nation’s health care system?
Their answer was succinct: There is no system.
Fragmentation and inefficiency are endemic, the group said. One participant described a revolving door of medical clinics, hospitals and private physicians. And no one knows what the others are doing.
They also indicted the insurance industry for placing a barrier between consumers and providers that is based on making a profit.
[blockquote]They also indicted the insurance industry for placing a barrier between consumers and providers that is based on making a profit. [/blockquote]
Odd, I don’t have that barrier when it comes to the liability, auto, life, homeowner’s, etc. insurance I carry. Now what could be the difference between health insurance and all these others?
Neither political party has addressed the primary issue, and that is not the matter of who is paying for health care, but rather why health care costs so much.
One reason why it costs so much, of course, is because we have unbelievably fancy facilities, drugs and equipment. However, we are using that equipment, those drugs and that equipment in incredibly inefficient and innapropriate ways.
The proof of that is that our life expectancy is not much better than that of other countries that spend less on healthcare than we do.
The reason why things are so expensive and inefficient is because of the principle of OPM. For those who don’t know, OPM stands for “other people’s money”.
You see, when doctors (such as myself!), patients, insurance companies and lawyers are spending OPM, cost is not an issue. The fact that one person is consuming, another person is selling, and a third person (the boss or the taxpayer) is footing the bill (and don’t forget the occasional lawyer who gets to raid the system in somewhat random and extravagent ways), the three parties will never be on the same page about what is appropriate or reasonable.
Case in point. 90 y/o demented patient comes to the ER with pneumonia. Her chances are very bad. Doctor tells family option 1. we can use some morphine to keep her comfortable, give some basic care like antibiotics and oxygen, No CPR or ventilators/specialists/ICU, and hope for the best, but she will probably die in 24 hours.
Option 2. Critical care consult, ventilator for 1 week, then she dies.
Difference in outcome none. Cost is unbelievably different, to the tune of $50,000 or more for the critical care. However, in general families choose option 2, because they think it shows that they love mama more if she stays in the ICU and mostly because they don’t have to pay. The doctor agrees because he gets paid more (by the taxpayers) and because the family is likely to threaten him with a lawsuit if mama dies somewhere other than the ICU.
Half of all medicare expenses are consumed by people in the last 3 months of their lives.
So, what to do? Unfortunately Hillary was half right. If the government is paying the bill, than patients and their doctors can not be allowed to decide what care is given. There is simply no way to pay for the health care inflation that has pushed prices through the roof. The big lie that Obama has told Americans is that they can have the health care that they have been getting (innapropriate antibiotics, futule heroic efforts, multiple unneeded drugs, etc) and just send the bill somewhere else.
Eventually, even in Obama’s “Medicare for all” plan, rationing will come-and it will not be pretty, and it will not be medically appropriate, and it will be decided in Washington by Congressmen. The actual cost of such care will be much, much greater than it would have cost had we not started the debacle of healthcare inflation through insurance to begin with.
My proposal is that we provide a minimal, basic standard of care, especially for people with chronic disease and children. I’ve imagined a system of county health departments staffed by NP’s and PA’s, where everyone can come for basic care. Yes, you will wait all day, there is no marble on the floors, and the people next to you might smell bad, but you will be seen at some point. Hospitals will be put on a budget and tailor their standard of care to stay within the budget that was given to them. This would stop the inapproprate futile heroic care and allow resources to be directed to where they can make a difference, prevention and chronic disease management.
Each year we can have the political debate about how much money we want to put into the indigent/charity system. It will never be enough and people will always complain, but at least everyone will get basic care and folks won’t die in the street. We could probably afford to hire busses to pick up the poor and transport them to the county clinic cheaper than we could send out phony Monopoly money Medicaid cards and pretend that private doctors can afford to see the patients for 30 cents on the dollar.
Let’s not forget what “Single Payer” means. It means outlawing private care. That means if Obamacare doesn’t cover what you want, YOU CANT BUY IT EITHER! Please note that a large amount of healcare received by Canadians (1/3 last time I checked) is done for cash across the border in the US. That’s because someone goes to jail if they pay a doctor to provide the service in Canada.
Note that the English system and that of many European countries is NOT “single payer”. That means if you want to spend extra money to get extravagent or innapropriate or just really expensive but marginally helpful care, you can pay for it or sell your house or raise the money some other way. All that and no one has to go to jail for seeing their doctor!!
Oh, and the lack of shared medical records contributes some to the cost, but the bigger issue is that alot of the “care” that is given doesn’t contribute to the patient’s better outcome. But people don’t ask why because they either feel guilty about choosing to endure so much “healthcare” or because someone else if paying the bill.
We don’t have to outlaw you hiring a doctor with so called “single payer” for doctors to start sharing medical records.
Also the idea that only a doctor–an MD at that–can provide excellent care is ludicrous. As mentioned above, Nurse Practitioners (NP) and Physicians’ Assistants (PA) are EXCELLENT health care providers, especially for primary care (which is what most of us need!)
When my friends tell me they want universal health care such as Obama is suggesting, I ask if they are willing to give up whatever care they currently have. I for one LOVE my provider (Kaiser) and would NOT want any less than what I get; but I know for a fact that I would pay more–MUCH more–and get less if we ALL are covered.
I have practiced before Medicare/Medicaid and after. We had health departments that had chronic disease clinics to take care of the hypertension, diabetes, arthritis, etc. clinics and charity hospitals. Training programs had free clinics in every speciality. They did a fabulous job. Not perfect but really good. I ran a health department prenatal and postpartum clinic and we had nurse midwives who delivered in the homes unless it was demed high risk. I had a 5% c-section rate (now 50% in our hospital) and while in the Army fell in love with the corpmen who did all the routine stuff by protocol. I actually saw about 7% of the patients–usually repeated visits, congresional enquiries about health of a soldier. They were like NP and PA’s 30 years before there were any in the civilian world. Capt. Jack Sparrow is exactly right. Federal mandates, legal problems, patient and family unreasonable demands and OPM have driven up the cost. I don’t see any real plan coming from the geniuses we elect to office. I guess their main talent is blaming those greedy doctors and hospitals instead. I hate to retire, but it gets easier every day and after every letter from the government, insurance companies, and lawyers. Enjoy
#1″ Odd, I don’t have that barrier when it comes to the liability, auto, life, homeowner’s, etc. insurance I carry. Now what could be the difference between health insurance and all these others?”
The difference (obviously) is that contrary to popular belief, old, infantile, sick, demented, psychotic, and fragile people are not “profitable”. They never were. Hospitals and physicians make their living soothing the imagined ills of the worried well, and by ministering to the minor hurts (appendicitis) of the easily cured. Every hospital and physician loses money on the really sick folks. Before medicare/medicaid these “unprofitable individuals” were cared for by the charity of physicians and of hospitals and it was clear that this was CHARITY. Physicians made up for it by charging wealthier and healthier folks more. Hospitals received donations for care.
Then, with the entrance of health insurance and medicare the idea came about that somehow health insurance should be just like car insurance. If a car is too unprofitable to insure, it doesn’t get insured. It gets stripped for spare parts and thrown on the dump. If a house is on fire, it doesn’t get insured. It’s not profitable. However this calculus does not work well with human beings because hospitals do not walk away from human beings when they become unprofitable. Neither do most physicians. Insurance acts as though we can and should, and has made a profit by doing so.
Patients (including the frailest and sickest who cost every physician who sees them money) do not see themselves as getting Charity (which they are) any more because they point out that they have “Medicare/Medicaid”. The fact that they are no longer grateful to be accepting charity is supposed to give them dignity somehow. However, since medicaid (and medicare) do not pay for costs it is still charity that folks on medicaid and medicare receive. It is simply charity that the government has taught patients to fail to appreciate.
I remember years ago while talking to a government wonk who said, ” we are going to cut the fat out of that hospital money for such things as surgery, deliveries, ER, etc.” My reply to him was that this “fat” was what helped pay for the trauma, cancer, premature newborns, severely ill, insane, etc. I have been proven correct.