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April 30, 2009

Health Care Reform Part 2

Patricia A. Kelly

While campaigning for the presidency, President Barack Obama came up with a health care reform plan, a public private partnership that he believes will help to clean up the present mess and provide closer to universal coverage in the United States. He has now asked Congress to work out the details, but his plan included the following elements:


1. A decrease in premiums.


2. Uninsured people will be able to purchase health insurance. If the cost is unaffordable for them, they will be eligible for a subsidy from the government.


3. Health insurance will be portable. If one changes jobs, he will be able to take his insurance with him.


4. The federal government will subsidize the cost of catastrophic care, saving insurance companies money, and helping to reduce premiums.


5. Insurance companies will be required to cover preventative care.


6. Hospitals and health care providers will be required to collect, track and publicly report measures of health care quality to insure that the health care dollar is being well spent. Federal insurance programs such as Medicare already deny payment for some hospital-acquired infections, inspiring hospitals to take more protective measures for patients. (Can you believe that they weren’t already doing this?)


7. Generic drugs would be increasingly available. U.S. drug companies would no longer be allowed to sell drugs in Canada and Europe for less than they do here. The prices would be the same. (Can you believe that U.S. drug companies are doing this, and, at the same time, lobbying to restrict Americans from purchasing drugs from other countries, suggesting they‘re not safe?)


These ideas have considerable merit. For those who believe government should remain small, they’re disturbing. However, the government is already subsidizing health care for the poor, and paying for catastrophic care, both for the uninsured and for those whose insurance limits have been reached. Paying for preventive care in an organized fashion could actually save tax dollars. If kidney failure, for example, were prevented because the person could obtain preventative care, then tax dollars wouldn’t be spent on dialysis.


Another change that I would recommend would be a change in the organization of medical practices to include more mid-level providers, such as nurse practitioners and physician assistants. Although the physician would still see patients frequently, his or her role would become more managerial, keeping up with medical advances, setting the tone for the practice, and directing or supervising the other practitioners.


The benefit of this would be that the physician’s income could remain high, with a large practice possible. The staff and the patients would have a better chance to get to know each other, which would decrease the unnecessary use of expensive technology.


If physicians knew their patients, they could better judge whether technology or watching and waiting would be appropriate. Now they often send the patient to the Emergency Department for extensive testing, just because they don’t know them well enough to know whether they will follow advice and follow up recommendations, or disappear for two weeks and then sue, blaming the physician for their failure to comply with their care plan.


A cultural change in our society would make a huge difference in our medical system, too.


We’re capitalists. That’s a good thing. However, it’s not a good thing for people in the “helping” lines of work to be concerned only with their own financial gain.


Insurance companies make money by not insuring people, or not paying claims. Drug companies make money by rushing drugs to market, promoting them as improvements, even before the data is really conclusive, and selling them for very high prices when they are under patent.


Physicians arrange care to maximize their reimbursement, even to scheduling two separate procedures when one would do, in order to make more money. Malpractice attorneys frequently demonstrate more concern about their income than about the genuine needs and appropriate awards for their clients. Consumers sue inappropriately.


We, as a people, can’t accept that there are things we can’t control. People get old and die. That’s okay because that‘s how we‘re designed. To put a fragile 90-year-old through heart valve replacement, or a debilitated, metastatic cancer patient on a ventilator and on multiple drugs to maintain organ function, mostly just prolongs suffering and wastes money, often leaving them to die inch by inch on life support instead of in a warm, clean bed holding the hand of a loved one. Not everyone can be saved.


We may depend too much on our technology. To try to have a baby when you’re 60, or when you have a life-threatening medical condition, may be expecting too much of our technology. When a hospital I once worked for lost two mothers due to complications of childbirth, the hospital received significant negative publicity. The women had both been warned that pregnancy and childbirth would likely cause their deaths. Maybe they, the world, and their insurance companies, would be a lot better off if they had adopted.


Maybe insurance shouldn’t cover high risk, complex, unnecessary medical choices.


We think we have the right to good health and to long, youthful life. We don’t. Sometimes we get lucky, and sometimes we don’t. We can contribute to our good health by making good life choices and collaborating with our health care team, but even the most high tech medical system can’t perform miracles.


A focus on preventive care and personal safety would save billions of dollars each year, and make our system much more effective.


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