Health Care Reform, Whither Thou Goest?
Maggi Cary
Primary season is in full swing with each candidate promising a better deal than the others. Healthcare reform is one of the top three or four concerns, depending upon your socioeconomic group and political affiliation. The last time this concern was front and center was in the 1992 Presidential election, extending into President Clinton’s first years in office.
I was still practicing medicine and did my best to care for my friends. An artist friend and his wife called me around that time to tell me they were expecting their first child and had no health insurance. They were also struggling with paying their rent and buying food.
Over the years I had arranged medical care for several people who needed more care than I could provide, but this was the first time I was in the market for a bartering obstetrician. I borrowed my artist friend’s portfolio, met a medical school classmate in a local restaurant and started the deal.
Each time I traded medical care for, among other things, dahlia bulbs, home made ravioli, acorn squash and art, I became increasingly frustrated. I could easily offer my own time. I was always successful at finding someone for my patients needing subspecialist care. I could do nothing about the black box of hospital, lab and x-ray costs.
I was intensely interested in the healthcare debates of the 1992 election. I left medical practice and went into policy work. I thought we could divide the blame equally among hospitals, insurance companies, physicians, pharmaceutical companies, malpractice lawyers, patients and anyone else involved and work on a solution.
I was wrong. Each time we focus on health care something small gets tweaked. Prices stabilize under national debate, everyone claims victory and then we return to the same perverse system with prices often rising to make up for the brief flat line. We have been through managed care, managed competition and other “solutions.” Each “father” of the latest trend trades on his creation in the press and moves into high priced consulting and conferences keynoting.
President Clinton’s Health Security Act was the biggest full-time employment act for lobbyists ever. Estimates were between $100 and 250 million dollars were spent on healthcare lobbying against the Health Security Act. This was during the time period we were wringing our hands about the US healthcare spend approaching a trillion dollars. We are now over two trillion.
We have the Tragedy of the Commons in health care. Then, as now, each group is more interested in capturing market share, or in getting elected, than in looking at health care from an overall perspective.
I have not heard anything from any candidate that effectively addresses the system changes we need. As Brian Klepper wrote, you show me yours and I’ll show you mine. All healthcare providers are required to have a National Provider Identifier, which makes tracking activity easier. Medicare will not be paying hospitals for treating some hospital-acquired infections and medical errors.
We have to know what we are buying to make informed decisions. Those in the industry should be rewarded to doing the right thing at the right place at the right time to the right patient, not for doing anything anywhere anytime to folks who may not need the treatment. We need a system that is transparent, quality-driven and does not distort economic incentives.
The ideal healthcare system will be an equal opportunity offender. No position is possible that will allow everyone to cheer on all points.
It should be unnecessary for every uninsured person to need a physician friend to get health care at an affordable rate.
Dr. Maggi Cary is Director of the Washington, DC office of the Institute for Medical Leadership. Click here to read her other posts. You can reach Dr. Cary at maggicary@aol.com.
The Doctor Weighs In
in The Doctor Weighs In, TDWI, Health reform, Maggi Cary, MD, Health care costs, Health care quality, Health care reform, Health care waste, Margaret Cary
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Response: Medicare = "No Pay"Maggi Cary, MD MBA MPH During my residency training “Private pay” entered on patients’ check in sheets often meant “no pay.”� Anyone with financial assets to protect would have medical insurance.� “No pay” was
Reader Comments (4)
I've also made the same points in the past: improving health care value is going to require transparency of information, and a real long term solution would require adjustments on every side of the equation.
Unfortunately, to get anything close to genuine transparency in health care outcomes and treatment data, the patient is going to have to not only accept responsibility for their own well being, but recognize that medicine remains an inexact science. We need to put a stop to the era of big lotto payoffs for malpractice suits before it is reasonable to ask health care providers to be completely transparent about using their best instincts, judgment calls and try-it-and-see solutions.
On the other hand, creating an environment in which the patient and health care provider are working together might also make it possible for enthusiastic collaboration between specialists, nurses, dieticians, et al.
The problem the US faces with our health care system is that what is broken isn't limited to economic factors. Or perhaps, a better way to say it is that economic factors have created a series of sub-cultural and social impediments to effective reform.
What do you think of today's front page NYT article on Medicare refusing to pay for medical errors?