100 years ago, the debate of healthcare as a right did not even exist. 100 years ago, there was little more than potions and theories of how to make sick people well. Some worked, some didn’t. The training of the “doctors” was little to non-existent. The cost? Maybe a chicken or whatever you had in the pantry.
There is a vast difference in the medical world of 1945 to that of 2002. Developments within medicine would have been expected but they have been in leaps in the last decades. Diseases that would have almost certainly killed in 1945 to 1950 are now usually treatable and in many instances curable.
Healthcare has become increasingly complex, expensive and successful in many areas of healing and in providing comfort over the last 60 years. Why? Advances in technology and a greater understanding of the amazing body we have been give have led to advances in medicine that were unheard of 50-60 years ago. All of this has come with a steep price tag.
Because of these advances, we find ourselves at a crossroad. How do we make it available to those who need it regardless of their ability to pay? How do we allocate the resources?
Would you be willing to have less, so someone else could have more?
If it is about limited resources, we should start the debate there. One place that should be addressed is the over-utilization of services and technology to reduce the risk of lawsuits or because of patient’s demands for services based on little evidence of improvement or benefit.
I think that healthcare reform should start with the root cause of over-utilization of limited resources to begin to expand coverage for all. Everyone will have to change the way they view and use the healthcare system to get healthcare reform.
My view of over-utilization of services comes from years as a case manager. Here are some areas that I think could be addressed without a change in services that bring benefit and value to people.
- Reduce the ordering of tests and procedures that are done for the benefit of lawsuit prevention. Tort reform for healthcare has to be addressed.
- Improve the physician’s ability to once again do physical exams and order tests based on their skill of diagnosing a patient and their symptoms vs. a shotgun approach with tests and procedures. (I go to a family practice physician that is one of the best diagnosticians I have ever seen. He can often diagnosis without a lot of tests. Because of this, the tests or procedures that are required are limited or targeted.)
- If a test or procedure will not change the treatment, is it really needed? Many physicians order expensive diagnostics even though the patient will not have the treatment or the treatment would not change the outcome.
- Use of protocols or evidence based medicine. Many physicians are not using protocols or evidence based medicine. They break the body up to so many consultants that I believe the care is much worse than a physician that sparingly uses consultants. (Ever heard of too many cooks in the kitchen?) Also, have you have wondered why there are physicians out there who routinely have a bunch of consultants on every case? I call it mafia medicine because everyone wants a piece of the pie.
- Reduce the use of ED’s as a point of care for everyone (even those with insurance). IMO, many ED physicians do not use their skills of assessment, due to fear of lawsuits. They are one of the most sued specialties. If someone comes in with a headache, they get a CAT scan, regardless of the physical assessment that says with 90{997ab4c1e65fa660c64e6dfea23d436a73c89d6254ad3ae72f887cf583448986} certainty, this is a simple migraine. That is why ED medicine is so expensive and the worst place to receive routine and non-urgent care.
- Medicare has to be reformed. I know that no one wants to go there but you come back to the question of benefit and limited resources. There are few controls on Medicare and people get whatever they want. Physicians get paid for quantity and not quality of services or outcomes. I am not for seniors not getting what they need but there are not unlimited resources and this is government money so there must be a limit. (If you will argue that you paid into the system, let me just say, you did not pay into the system as much as many are getting out of it and most of it in the last 6 months of life. If that is the case, then we need to get rid of Medicare as a coverage for all Seniors and have people pay into insurance and private policies at rates that would cover the care they will receive in the senior years. Then they can choose how much care they want and how much they are willing to pay for it. Then those that can’t afford it can stay on the government insurance and get what they allow; which will be limited and rationed. No futile care.)
I will end this post with a question?
Would you be willing to sacrifice your “right” to have everything you wanted in healthcare no matter the limited benefit so others could have healthcare that has proven benefits?
I am as concerned about the suffering of others as much as I am about my own. How could I not give up my demands for care that may have only a 2-5{997ab4c1e65fa660c64e6dfea23d436a73c89d6254ad3ae72f887cf583448986} chance of making me better for someone to have care that will certainly cure them? Though I don’t want the government deciding this, that is my reason for wanting to move to things that will change over-utilization without government takeover.
- Tort reform
- Change in physician payment for Medicare that mirrors the hospitals DRG payment which discourages over-utilization.
- Penalties for ED use for routine care.
- Use of “Medical Homes” for the socialized medicine programs (Medicaid and Medicare) to ensure that they do not use ED for routine or non-urgent care.
- Address Uninsured by root cause analysis:
- Address issues of why people do not take out insurance with their employer when available.
- Address group of people who work but are not offered health insurance.
We need commonsense approaches that are slow and measured to make this work and not break a system that encourages innovation that is second to none.