If you want to seriously look at health care reform there is only one place to start, with the service and benefits you intend to provide. Anyone can say that they want the citizens of the United States to be healthy. It’s in the specifics that we have problems. Everyone’s in favor of motherhood and apple pie but what if the apple pie has worms and mother has gonorrhea? Are you still in favor of motherhood and apple pie? You cannot say ‘yes’ to anything unless you are willing to say ‘no’ to other things. The other 17 western democracies, all of which have some degree of governmental control of health care, have at least a process in place to decide service and benefits. The question is not whether someone wants good health for the American people, its whether they honestly believe that bone marrow transplants are warranted in stage two breast cancer. If they can’t answer that question they really have no business commenting on health care initiatives in America. You have to drink deeply of this well or not at all.
The second major area of health care planning is the basic science which goes with it. The current scientific basis for medicine is moving at an astounding pace. Scientific potential, however, has gone way beyond the scientific output. When the human genome project concluded, we expected that within a few years most diseases would have been conquered. This is far from the case. More direction is needed in deciding where health care dollars should be spent and exactly what problems we want solved. The major problem in the country is not the science, it’s the application of that science in turning out positive results for the American people. For instance, I have no idea why every health care plan – at least in my state – recognizes chiropractic care. What is the scientific basis that defends why this should be maintained? It will take a government with courage to actually look at what is now being paid for and withdraw it as an option to be funded publicly.
The real question is not whether a service will be available, it’s who’s going to pay for it. Great Britain runs a health care system which clearly has two elements. About 90 percent of the care is funded by the government but there is another active 10 percent of medical services which are paid for out of pocket. It is this dichotomy between what is in the public sphere and the private sphere which is the issue. No one in the United States would be in the favor of taking away a patient’s right to receive any type of care they wish. The question is whether we as a group of citizens are willing to pay for that care and whether we think it needs to be provided on a broad distribution basis. That issue, of applying science to what will be provided, is an area where intelligence and factual knowledge of health care is absolutely required. No candidate at this point in time is willing to speak to those issues.
The last three areas which need to be discussed are the heath care workforce, legal system and finances. These questions are the very basis of any change in the health care system and require further delineation beyond what this column can provide. We’ll pick this up where we left off next month.
Greg Henry, MD, is the founder and CEO of Medical Practice Risk Assessment, Inc. Dr. Henry is a past president of ACEP and has directed an ED for 21 years.
6 Comments
Scrubs are the reason I got into medicine.
I can’t agree more mark , we need people like you here , unfortunately we are shifting our resources overseas , and leaving our country in shambles , i don’t understand why we self-destroy ourselves , what the point of taking bright professionals like you half the way aroundd the world and our still not fixed yet , i am going to lobby hard in washington to get guys back here , so we can get back on track and move on out of this pity hole.
You are correct in that everybody is going to need to give up something. Drug companies their enormous profits. Insurance companies their enormous profits. AARP their “do everything for every old person forever, no matter what.” Trial lawyers their nonsensical theories of injury. Government their expensive and often baseless policies and regs. Doctors their “nobody can do it but us turf issues. The public’s “we don’t care what it costs, we want everything” attitude. Ethicists’ their “cost cannot be a factor when life is at stake” mantra.
Hard choices?: What about the enormous amount spent on extreme preemies. What about the enormous amount spent on end of life care? What about taxing the life style “choices” that contribute so much to health care costs and devoting that money to, oh I don’t know, health care?
The problem is, there are large and powerful constituencies out there opposed to every one or another part of this. No one is willing to give up their part. And so, nothing gets done.
Good luck in Iraq. Keep your head down anyway. It’s not that damn safe.
Michael Nerenberg MD
It is essential that what ever the solution to the Health Care issue, it needs to
include personal responsibility built in to the mix.
Probably financial reward/penalty for good/poor health practices and “use/abuse” or resources.
The concept of “my insurance will pay for it” is disastrous, as is
the sense of “entitlement” to have any and all testing, treatments, etc.
Thank you Dr. Henry for those very insightful comments. I have no doubt that both presidential candidates are very reluctant to give any position statements other than very general descriptions – neither of them wants to bring up the unpleasant facts. Dr. Henry states: “If you want to seriously look at health care reform there is only one place to start, with the service and benefits you intend to provide.” And that’s exactly where both candidates are afraid that if they come out with ANY limitation whatsoever, they’re going to appear unpopular to many.
This discussion is not just for healthcare people, but it isn’t going to become a subject of much general discussion until we ALL feel the pain of not being able to get to a doctor when we need one.
If a 2yo has a forehead hematoma from a fall while running, but is otherwise completely normal, would you scan? In general, I would not scan for a forehead hematoma but would consider a scan for scalp hematomas.