Thursday, February 7, 2008

Universal Health Care: What’s Wrong with This Picture?

Survey results in a recent article in the New England Journal of Medicine(1) show Democrats and Republican have very different views about our health care system. Democrats are not happy with the system and want universal coverage, even if it means more government involvement and higher spending. Republicans, on the other hand, are more satisfied with our present system and are more concerned with controlling costs. They favor private insurance solutions and tax breaks to decrease the number of uninsured people.

Both sides miss the point. The question is not how to finance our health care system. The question is why do we spend more money per person than other developed country, but still have more than 47 million people uninsured and lower life expectancies? Current health care costs are running around $2 trillion a year – about $7 thousand for every man, woman and child.

The reasons for this are not difficult to understand. Some of our excess costs are attributable to higher prices for medical goods and services and considerably higher administrative costs. But the big problem is our technological and procedural style of medicine, fostered by the reimbursement system of Medicare and other insurers. We pay for procedures and not for clear thinking. There are several reasons for this, and I’ll examine each of them in detail in future posts.

1. Primary care (family doctor, general internist and pediatrician) has been under funded for decades, resulting in an acute shortage of primary care physicians. The old-fashioned doctor/patient relationship that provided critical insights into individual patient care is virtually non-existent.

2. There is no system of physician oversight in either hospitals or nursing homes to make sure that patients are receiving only beneficial care and not care that means a bigger tab to bill the insurance companies or Medicare/Medicaid, without any real advantage for the patient.

3. There are no controls on drug and medical device manufacturers in terms of research validity and funding, lobbying Congress to approve their products for Medicare/Medicaid coverage, or advertising their wares to the public.

4. End-of-life care in large teaching hospitals is more costly, yet the death rates are higher. There is more emphasis on expensive high-tech procedures, whether the patient will benefit or not.

Approximately 17% of gross domestic product now goes to health care. That’s a significant drag on our economy, especially when compared to other countries. There is no question we need universal coverage, but to get it without bringing our economy to its knees we must change the way we practice medicine.
(1)Blendon RJ, Altman DE, Deane C, Benson JM, Brodie M, Buhr T. Health Care in the 2008 Presidential Primaries. New England Journal of Medicine, 2008;358:414-422 (PMID 18216365)


Bailey said...

Hello -
I am a documentary maker and hospice volunteer in Atlanta, Georgia.
I've produced a short documentary about end-of- life decision making, palliative care, caregiving and hospice.

It's called 203 Days.
You can view it in its entirety at the following University of Connecticut website along with a study guide.
It is an unflinching look at the day-to-day interactions between patient and caregiver, in this case an 89 year old woman who is living with her daughter.

203 Days recently won the First Place 2007 Film Award from the National Hospice and Palliative Care Organization (NHPCO).

If you'd like more information please go to my website

I hope this film is helpful to people who want to know more about some of the most common experiences for caregiver and patient at this difficult time.

Bailey Barashzj

Doctor Kenneth Fisher said...

Hi, Bailey,

Thank you for posting on my blog. I visited both your web site and watched the video. I believe you are doing important and outstanding work on behalf of bringing humanity and appropriateness to end-of-life care. Your message is of critical importance to the public, the government and the medical profession. I hope you will join the grass roots movement to reform our distressed medical system and start doing so by downloading and faxing my form (available on the right hand side of the blog) to your Congress Person and Senators.