Healthcare Reform: Is Anyone Listening?
Monday, December 15, 2008 at 08:11PM
In recent years, as a medical director in a large hospital system, I have seen and written about so many abuses of our present healthcare system that I have just about given up, saying it’s no use. Just in case someone might be interested, keep reading for a list of what I’ve found:
1. Scores of uninsured patients coming to the emergency room with problems for which they had delayed seeking treatment because they had neither insurance coverage nor financial means to self-pay—leading to costly care and morbid outcomes which could have been prevented by timely intervention.
2. Adverse events, too often sentinel events, from medication errors that could have been avoided had there been a system whereby a primary care physician monitored the patients care and medications.
3. A plethora of medically unnecessary diagnostic testing—laboratory, radiological, nuclear imaging; and medically unnecessary overutilization of ancillary service—home health nursing, physical therapy, durable medical equipment.
4. Blatant disregard by attending and consulting physicians for appropriate utilization of acute inpatient hospital care.
5. Reduction of reimbursement to primary care physicians—the very caregiver who is in a position to control unnecessary costs and utilization, and to oversee quality of care.
6. A reluctance of graduating physicians to enter primary care training, because of the reimbursement issue, and instead pursue monetary rewarding specialities.
7. Unreasonable denial of benefits by insurance carriers in order to increase profit margins.
8. Health insurance carriers refusing coverage and/or requiring exorbitant deductibles for covering select groups (cherry-picking) thereby shifting costs of medical care to tax supported federally funded entities.
9. Referrals of patients by physicians to entities, such as Day Surgery Units, Specialty Hospitals, Imaging Centers, Physical Therapy, Home Health Agencies, IV Therapy Companies in which the referring physician has a financial interest or from which the referring physician receives a stipend, often in a disguised form, in return for referrals.
10, Ineffective peer review programs by healthcare organizations that seldom adequately address performance issues or gross quality issues.
11. Joint venture relationships between physicians and hospitals that manage to circumvent statutory requirements for transparency and reward physician-partners for admission referrals.
Opponents of any form of a single-payer healthcare system often refer to the complaints that arise from systems in other countries, such as England and Canada regarding delays in receiving treatment. If statistics from those countries are analyzed, the only delays in those countries are cases where there is no emergency or urgency. There might be inconvenience from waiting times but neither patient satisfaction nor overall outcome of care is found to be affected.
A continuation of the status quo system—a system where more is better whether or not it is medically necessary—regardless how it’s tweaked, will not work. Our present healthcare system is such that if the cost escalates, insurance carriers, even tax supported federally funded programs, Medicare and Medicaid, simply raise the premiums, the co-pays and deductibles, thus forcing the consumer to pay for the run-away increases. Incentives for providers to provide more services for financial gain, with third parties paying for the cost, has to be removed before any reform will work.
The real test of effectiveness of any healthcare reform effort will be whether or not our lawmakers are brave enough, and will be kept knowledgeable enough, to ignore lobbyists paid by special interest organizations and whether they will recognize wherein the problem lies.
http://www.charlesclarknovels.com
Reader Comments (7)
Sigh....this is all so deeply disturbing.
My father is a surgeon, and I am currently working on a research project studying access to publicly funded mental health care for monolingual adult patients, so your words are resonating deeply with me.
I am glad you are running this site, and I will post some of your words on the blog. Thank you for commenting on Obama IS America!
Also, the Obama Transition Team is trying to get people to host community forums within their homes about ideas on how to transform the healthcare system. here is a link:
http://change.gov/page/s/hcdiscussion
You should participate if you can! I'm sure you could come up with a bundle of excellent policy recommendations. If you want some ideas on how to structure/organize a forum such as this, or engage in a discussion on these issues, please send an email to: obama.is.america@gmail.com
Thank you for your work!!!!!
Doctor,
I am sure that the issues above exist, but how many of them would be solved by some form og Government provided health care? For example, issue #2 would seem to be at work independant of the system?
While I have no doubt that the health care system is broken, i am not sure that public funded care is the best solution. Are there others that you have considered and disqualified?
Thank you, thank you, thank you!! For bringing this much needed topic up. As for the comment by Pino - obviously you are not in the medical profession. Don't get mad at me but please do your best to educate yourself on the details of how our current system works or fails to work in my opinion. I'm a hospital clinical pharmacist and I see many of the issues that the medical director has discussed. If you want a simple to understand explanation of how our system and healthcare systems around the world work then please watch these two programs on PBS Frontline:
Sick Around America - www.pbs.org/wgbh/pages/frontline/sickaroundamerica/view
and
Sick Around The World - www.pbs.org/wgbh/pages/frontline/sickaroundtheworld
Our system is unsustainable. We can either be stubborn and fail to accept the facts or be part of the solution. If you're reading this then wouldn't you rather be part of the solution?
No doubt there are problems in health care. I see the problem to be complex and a government solution seems any but efficient. If private insurers help to create problems how much greater would be a government solution? One only need look at the slick efficient operations at Medicare to see. If a limited program that only helps some and taxes EVERYONE is threatened to go broke what can we expect from this monster? Also they are talking about taxing insurance plans to pay for it. Meanwhile page 16 of the house version is clear that no new private insurance policies can be issued. So not only will this plan eliminate the competition but iut expects the competition to pay for it. I call that idiotic and the people proposing it idiots. If they are thinking like this what other asinine components hide in the legalese.
Point 1. I agree with this program but ask this. How many of those uninsured emergency room patients were illegal aliens? How many could have afforded the insurance but had opted not to buy it? I know a young man 25, making $65k who opted not to buy the very affordable full coverage our company offers. He began having stomach pains and like most 20-somethings he ignored it until he passed out on the job and had to be rushed to emergency. He had an intestinal infection that required hospitalization. Should I pay for that? No, he made his choice.
Point 2, 9, 10, & 11. Great points. There should be physician accountability. Conflicts of interest should be discouraged and penalized. This is an area government should regulate and create safer medical environments. Is this an argument for a single payer system as being proposed in the House? Or would true health reform seek to regulate rather than nationalize.
Point 3. I believe (based on conversations with 6-8 doctors and online research) that much of this comes from the threat of litigation. I know of a woman now suing her doctor because he failed to test her for the cancer they eventually found, even though her complaints suggested another problem and she failed to push for additional tests. Also my wife discovered she was stage 3-4 with breast cancer in her lymph system when she insisted on an MRI under her arm after she experience pain there that the doctors were certain was nothing more than a pulled muscle. I think a government system would not be as flexible as Kaiser was in allowing the test.
Point 6 & 7. I see this intensifying under a government payer system. Do you disagree? they are already discussing reductions in services before passing the bill. CNN only today posed the question "what should we give up for national health care?" I thought people were looking to "get" something not give things up.
Point 8. Under the House proposal this becomes a moot point since within 2-3 years there will be few private insurance carriers operating in the U.S. - The one servicing Congress and the President who will have prime policies and very expensive executive policies - everyone else will have government health care.
My fear is that there is another agenda being pursued here and the result will be lower health care standards, reduced availability, and retarded medical R&D.
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