The Healthcare Crisis- One Doctor's View
These are historic times in healthcare. America is in the midst of a huge, seemingly insurmountable healthcare problem put before politicians to untangle. The Supreme Court has even debated recently on the constitutionality of the prevailing plan to restructure healthcare.
Though I am just a tiny fish in the huge sea of this turmoil, I am regularly asked by family, friends and patients about my views on this epic struggle.
This blog will offer a glimpse of these views. ( But be mindful that this is my opinion as that tiny fish that swims around the ocean every day.)
A Nation Divided - Where's the Group Spirit?
I believe that each era involves a major problem for society to overcome. In the 1940’s America had the Axis powers to contend with as a player in a world-wide war. America responded. Some went to fight. Others went to work in factories to support the war effort. People bought war bonds. Children collected scrap metal. Food was rationed. Everyone seemed to tighten their belts a notch to do what they could.
Where is that esprit de corps with the healthcare crisis?
People analyze the problem by pointing fingers and expressing fault. Groups with a special interest spend huge amounts of money to lobby politicians involved in shaping what healthcare will look like. The prevailing thought seems to be, “Go ahead and change healthcare, but don’t change my piece of it.” Doctors, insurance companies, pharmaceutical companies, vendors and patients need to concede if there is to be any winners in this tremendous battle to create something worthwhile.
Let’s Face It - Healthcare is Expensive.
In my care of patients, I try hard to practice judicious care of medicine no matter who is paying. Hearing, “Order whatever tests you can, my insurance is paying,” is bothersome to me. Someone is footing the bill and I try to act the same whether they are in the room or not.
End of Life Care
Most of our healthcare expenses come in our final weeks of life and unfortunately, much of this care is both futile and undesired. In part, this is the fault of some medical personal who see death as failure and either magnify the potential of therapy or do not communicate thoroughly with patients about expected outcomes. Additionally, many patients fail to communicate their wishes before the reach this stage, leaving the decisions to family members who feel they must do everything possible. These factors culminate in a lot of unnecessary treatment at a hefty cost to the medical system.
Years of observed Medicaid abuse often leaves healthcare providers jaded. Admittedly, I am one to some extent. The emergency rooms catch the brunt of this.
To illustrate a point, let’s say hypothetically that a person is in need of a car. I have an extra car and I give it to the person because I feel that people have a right to drive cars. However, if this person ran it hard, didn't change the oil, messed up the interior, I would be upset.
Like the above example, many persons with Medicaid use the ER for basic care.
This amounts to a HUGE unnecessary cost. The cost differential for the evaluation of a sore throat between the ER and a primary care physician runs around 8 to 10 fold!
Many patients of mine with “Cadillac” HMO insurance are required to call for authorization for ER services (if possible). I just don’t understand why this sort of management is not required with Medicaid.
The current health care system is a big mess, few would disagree. We should be thankful for the high-end advanced care available here in America and do what needs to be done to preserve that excellent care and put it in reach of all.
Though I don’t have the answers as to what will work, I do know that it will take a conscious effort on the part of every American no matter what their role may be. May we all tighten our belts as we are able, trading any sense of entitlement for a sense of collective responsibility toward mending the problem.
Photo Credit: aflcio