By David Birdsall MD
As an emergency physician and hospital Chief of Staff, I can honestly say that not since Medicare has there been such a boisterous and spirited debate regarding health care.
Until recently, when I was asked what we should do to fix health care, I took a thoughtful pause (at least that was the look I was going for) before opining ontort reform. “Just reign in the lawyers. That should take care of everything,” one colleague claimed.
While malpractice suits are a big problem, they’re just one of the symptoms of the
very complex disease that is our national health care system. And just like a complex disease, we need multiple “specialists” to work together to cure it.
We in the U.S. claim to have the best health care in the world, yet only 40% of those polled were satisfied with their health care. Compare that to Denmark’s 91%, Austria’s 73%, and France’s 61% (France is rated the best health care in the world by many.) How do we judge success with that variance?
Yet, if we continue along our same path, Medicare will be bankrupt in six to eight years and we’ll continue to fall farther behind other industrialized nations.
So what should we do and what model should we follow? Should we look at France and Japan who provide health care using private insurance financed by employers and employees, and accomplished through tight regulation of cost and utilization?
Or perhaps the U.K., which finances health care through large income and sales tax revenues.
We could look at Canada which uses a system where the payer and the insurer is the government and the providers are private.
Or what about Third World countries who make health care selfpay.
No matter the direction, I believe we should heed the standards employed by all the top health care systems around the world in the following areas:
1. Insurance companies should be “not for profit” with regard to basic medical care (U.S. insurance companies only pay 80 cents of each premium dollar on health care compared to 90-95 cents elsewhere. Why? Because these companies have to make a profit for shareholders.)
2. Costs and charges need to be contained and standardized. A CT exam at one hospital should cost the same at another. Clearly, this will require changes in our payment structure, which needs to be changed anyway.
3. Utilization needs to be curtailed. For many reasons we order more tests and perform more procedures than most other countries. Japan is the exception, but they have tight cost controls.
4. Quality of care should be high.
5. Preventative and primary care should be stressed (in the U.K., 60% of
all physicians are in primary care vs.35% in the U.S.).
6. Health care should be provided for all (regardless of employment status or pre-existing conditions) with all citizens contributing to that end. This means that everyone, except the
extremely poor, pays into the system in some form or fashion.
Health care reform in its current state is not the complete answer but it has gotten the ball rolling. The one thing that is clear is that physicians need to be intimately involved in whatever reforms or changes are made. We need to stick up for our patients, ourselves and our hospitals. Do you agree?