There is an excellent article in The Atlantic by David Goldhill entitled How American Health Care Killed My Father.
There has been something that in my gut has been annoying me about the whole health care reform debacle and Goldhill has hit it. Essentially, reform does not reform if you think of reform as something that uncovers and fixes the systemic issue at the core of this crisis.
Much of the debate is about covering those who do not have insurance and shoring up some other fundamental inadequacies such as being denied insurance for pre-existing conditions. Certainly we need to do that.
But I contend that once some of these basis changes are made we will have a worse problem. All of a sudden the system will be deluged with people seeking care. And with a shortage of primary care physicians to serve us, patients will end up in the emergency department at the local hospital, likely adding more costs to health care.
Goldhill says this: ÛÏfundamentally, the ÛÏcomprehensiveÛ reform being contemplated merely cements in place the current systemÛÓinsurance-based, employment-centered, administratively complex. It addresses the underlying causes of our health-care crisis only obliquely, if at all; indeed, by extending the current system to more people, it will likely increase the ultimate cost of true reform.Û
He goes on to say that providers do not serve the consumer but the insurer. That gets back to the Atul GuwandeÛªs article ÛÒPiecework – that I cited in a previous blog. Providers get paid not for quality but for the number of tests and procedures they perform. Granted there is more value based purchasing / pay for performance taking place but as the author pointed out, if health care workers had simply washed their hands, his father would not be dead. Those simple, no cost behaviors have been shown to drastically reduce infection rates. Yet that is not necessarily how hospitals and doctors get paid. Ironically it is almost as if the hospital in his case was eating its young. It is their very own bad infection control practices that contributed to his fatherÛªs complicated stay, intensive care visit and a subsequent $600,000+ bill.
He further makes the point that I refer more to the entitlement attitude we have in this country, at least for those of us that are insured. Here is his quote: ÛÏHealth insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. WeÛªve become so used to health insurance that we donÛªt realize how absurd that is. We canÛªt imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance.Û
Used to be a doctor would visit your house and you would pay him/her cash. Insurance was for catastrophic care. Perhaps physicians with concierge practices have it right, especially people like Jay Parkinson, M.D. who make it affordable and patient centered. Certainly we have learned to accept that we are going to basically pay out of pocket for our dental care. The dental industry simply said we are not going to play by everybody elseÛªs rules.
This article is long but worth the read. Perhaps WalMart should fix health care – retail health clinics where you pay out of pocket for affordable coverage; $4 prescriptions. Add some self-responsibility on our part in taking better care of ourselves in a fast food obsessed nation that is destroying our health. Then save the insurance for the times you truly need it.
Health reform is putting the proverbial band-aid on a solution that needs surgery. Extreme Makeover: Healthcare Edition