Thursday, November 13, 2008

The Election is Over, the Health Care Crisis Still Looms, So Now What?

As the national election drew near, a spate of Perspective articles in the New England Journal of Medicine discussed the problems and possible solutions to providing universal health care coverage. Most begin with the now familiar litany of problems with our present system: greater percentage of gross domestic product (GDP) spent on health care than any other nation yet millions are under and uninsured, poor results when compared to other nations, and an economic burden that is costing jobs while lowering the standard of living of the middle class.
The first four papers were from each of the presidential campaigns and then a rebuttal. The Obama campaign identified many of the problems in our system. Although the excessive costs of our present practice of medicine were discussed, the solutions were superficial and vague. While more uninsured would be covered, the anticipated increase in spending would make these reforms unattainable or so expensive as to cause more chaos to our economy.
The McCain campaign, although recognizing many of the American people’s concerns, offered a solution that is primarily a change in payment scheme. Again the fundamental problems existent with our health care system were not addressed; instead the plan relied on patient dollars to create a savvy consumer able to wisely purchase services, although they are extremely complex with consumerism a major problem driving up costs.
The Obama campaign countered the McCain plan as completely unrealistic and probably causing more harm than good. The McCain campaign responded to the Obama plan as unrealistic and, if enacted, prohibitively expensive. In my opinion both rebuttals were correct.
Following these exchanges, three health policy experts wrote about their ideas for changing the health care system. They argued for control of the growth of health care spending without which any attempt at universal coverage will fail. They stated that a large reason for the increase in costs is new technology and drugs. To deal with this problem they support the creation of an independent well-funded organization fashioned after the British National Institute for Health and Clinical Excellence.
I disagree with this idea for several reasons:
1) We already have a well-funded entity with known scientific excellence – The National Institutes of Health (NIH).
2) Drug and device companies now fund a great deal of research for use in clinical practice, which we know is frequently biased. Therefore, I suggest that Congress enacts legislation requiring all drug and device clinical research monies spent by the companies go through the NIH for experimental design, execution and reporting. This would ensure more valid data.
3) My proposal of the health care “Bank" would then enforce the concept that only therapies of benefit would be funded.
4) My appropriate care committee system would insure that these decisions are tailored to each individual’s needs and not applied in an autocratic manner. These changes would be part of the medical system and thus would not require the creation of another expensive bureaucracy. As mentioned in a previous post, the “Bank” would adequately fund and also enlist specialists to provide primary care, the backbone of any successful health care system and dramatically lacking in our country.
Unfortunately none of the articles dealt with medical advertising to the public (which should be prohibited), the growth of medical consumerism and the overuse of Cardiopulmonary Resuscitation and the flaws in Advanced Directives that have substantially increased health care costs. It seems that no one wishes to tackle our outrageous end-of-life care, the suffering it causes to patients, and its cost to our society. My hospital admission form and the appropriate care committee system would address these problems. We can provide world class care, universal coverage, decrease the percentage of GDP spent on health care and thus greatly enhance our standard of living by adopting my three major proposals (hospital admission form, appropriate care committees and the “Bank”).

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