Monday Musings for Monday April 22, 2013
Volume III, No. 15 /118
(Editor’s Note: Much has been said and written about the 2000 plus pages of ‘Obamacare’ which I have recently finished reading. It is a boring document written in arcane language with abundant legalese absurdities and bureaucratic banalities. We are devoting two ‘MM’s to bring some clarity to the matter, since 2014 will be the year much of the law will take effect. Today’s column are some thoughts about what will help, and next week Dr.Ted Kunstling, a pulmonologist and Medical Director, Duke Raleigh Hospital, will continue with his reflections).
Health Care Reform (Part I)
By Assad Meymandi, MD, PhD, DLFAPA*
Socratic elenchus and Aristotelian entelechy are elegant, and the prose of Plato, is lyrical and beautiful. All three in their discourse ask ‘Who are you? What do you do?’ ‘Are you and your lives making any difference?’ I apply the same to health care in America. What are we, what do we do? And what we are doing is making any difference? American healthcare is the costliest in the world, yet quality is patchy and millions are uninsured. Incentives both for patients and suppliers need urgent treatment. The cost of healthcare in one state of Indiana is more than the entire country of India. America spends twice as much per person on health care as Swedes do. Yet there are over 50 million uninsured and many more under-insured. We are spending 17%, soon to be 20% of gross domestic product (GDP) on health care, the most expensive in the world. Literally, billions of words have been written since the Truman administration attempted health care reform. Surely, billions more words will be written before we arrive at a satisfactory solution. Meantime, here are some practical and simple suggestions to ward off the current crisis.
1) Number one money guzzler is obesity. Obesity causes diabetes, cardiovascular disease, hypertension, musculoskeletal problems, back pain, and stroke. The cost of cardiac bypass is $18,000 to $20,000. The cost of back surgery, ninety percent related to obesity, is in the tens of billions. If we could prevent even a small percentage of people from becoming obese, we could drastically reduce medical expense. We need preventive measure and offer incentive to healthy eating and exercise.
2) Reimbursement issue: The system encourages doing procedures and very expensive lab tests and scans. The system does not pay for process and thinking medicine. This flawed system drives the doctors to spend less time with their patients. I do know that inflation adjusted, primary care physicians are receiving one third less pay today than they did 20 years ago.
3) Government mandated single payer may be the answer. But look at Canada and England. It takes as long as three years to get elective surgery. That is not consistent with the temperament of freedom seeking Americans.
4) For-profit driven health care companies should be banned. The middle man and health care insurance companies/venders are poisonous. The dollars that should go to patient care go to pay the salaries, bonuses and backdated stock options of the company’s chief executive officers and their staffs. Convicted Richard Scrushy of Health South and William McGuire of United Healthcare and many others like him are examples of these unwelcome middle-man-intruders in medicine.
5) Waste, repetitious expensive lab work, million- dollar work- ups are common place in medicine. The primary cause, besides financial incentive of the sinister “more-lab-work-you-do, the-more-fees-you-collect”, is the practice of defensive medicine. We need some comprehensive tort reform to keep physicians from over ordering. The fear of malpractice litigation does indeed lead the doctors to order tests that may not be necessary to the patient’s care, resulting in billions of dollars of needless expenditure.
6) There is no question that there are a few bad apples in the barrel. The holy house of medicine does have contaminants. There are a few physicians who go into medicine for anticipated financial rewards, but they are not very many. For most, doctors consider medicine a calling, and their sacred profession, a priesthood. But we do need to keep a closer eye on the few bad apples, thus requiring us to strengthen the NC Medical Board.
7) Finally, In order to reduce cost, we must emphasize and preach the gospel of prevention. Recently in a health related meeting with several people, among them Lanier Cansler, Secretary, NC Health and Human Services, I asked what percentage of the Department’s budget is spent on prevention. It is an astonishing 5% to 7%. I believe we should approach this issue with thoughtful planning, but a revolutionary attitude. We must effectively combat the unwelcome and dangerous epidemic of obesity.
*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012).He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.