Tuesday, November 06, 2007

My answer...once again

This was originally posted on Dec 28, 2006, but is reposted as my answer to our health care problems. It was originally a 2 part post, so I apologize for the lengthiness.

The Dems are lining up for their respective presidential runs and based on the last election there is a good chance that a Democrat will be in the White House. What does that mean for folks like me in the medical community? Well, I think it means trouble.There are some serious problems in America’s current health care system. No one can argue that point. However, our politicians seem to have a difficult time acknowledging the real problems we face. For some reason, Washington thinks that our only health care problem is the number of uninsured, and once that’s fixed then everything will be fine. Just get every citizen health insurance and the healthcare problems will vanish. Wrong.

So I have included a few tips, in simple terms for our politicians, on how to fix America’s healthcare. First, the little things:

Ban drug company advertising for prescription drugs. This was a huge mistake by Congress. Why do people need to know about prescription drugs? Isn’t that what doctors go to school for? It may seem like a good idea on the surface, but what it does is create unnecessary visits for things that aren’t necessarily problematic. For example, a recent commercial says "talk to you doctor if you’ve ever had problems sleeping". Well, who hasn’t had problems sleeping? Now, patients are making appointments for things that aren’t pathologic but are rather normal human variations in health. The result: costs go up and access to care goes down. Not to mention the fact that drug companies are better spending this money on other things like research and development.

Impose strict malpractice reform. Trial lawyers must be reigned in. They are out of control and they are ruining our healthcare system. The fear of being sued among physicians is driving us to practice defensive medicine. Labs, tests and scans are being ordered mainly as cover, even when they aren’t exactly necessary. This drives up costs. And since it’s usually the lower socioeconomic class that tends to be sue happy, they obviously can’t afford the extraneous tests, and the cost gets passed to other consumers. Plus, malpractice insurance is becoming too expensive and it’s driving physicians out of practice, thus increasing demand for care and limiting access. We need to impose caps on damages and harsh penalties on plaintiffs attorneys who file frivolous suits, including forcing them to pay ALL court costs (including the defense) for any suit they lose. Do this, and malpractice lawsuits will drop substantially.

Stay away from socialized medicine. This simply doesn’t work in a capitalist environment. It’s way too expensive and will bankrupt the federal government. What would happen if healthcare were free for everyone? Long lines, poor quality, limited access and huge taxes. It’s not the answer.

Keep Health Savings Accounts. Luckily, Congress passed this before disbanding. Basically, this allows people to save money, untaxed, for healthcare reasons while purchasing a high-deductible insurance policy for the big costs. It’s a great idea and I hope the new Congress doesn’t sink it.

Lower taxes on corporations. We have free trade with many countries. The problem is that the taxes here are higher for corporations than they are oversees. The result is the outsourcing of jobs and the loss of health coverage. In order for free trade to work for us, we need to lower corporate taxes to attract more international business and keep domestic business here. That means more jobs are created and more people are insured.

Allow small business to pool their resources and purchase large corporate policies for their employees. Why hasn’t this been done yet? Likely because the insurance lobby is awfully powerful. Small businesses simply don’t have the income to provide quality insurance for their employees, mainly because purchasing plans for a dozen people is too expensive. The larger companies get discounted care because they bring in more customers. It’s not exactly fair, but that’s how private insurance works. Hey, they have to pay their own bills. So, why not let small businesses come together under one plan? Where is the hangup here?

Allow physicians to practice concierge medicine. Dr. Vic Wood of West Virginia offers patients unlimited primary and urgent care for $83 a month. UNLIMITED. This doesn’t cover hospitalizations, medications or specialist care, but at least it’s something. It certainly beats an $800 ER bill for a sinus infection. Doctors can do this and still make a living, and it helps ease the uninsured burden. Similar plans can be found throughout the country. The Family Practitioners have found a way to help people who need help. So what’s the problem? Well, in some eyes, this amounts to operating as an illegal insurer. Who’s complaining? The insurance companies. This method eliminates the middle man thereby taking away from insurer profits. So they have to respond with lower rates themselves. Such is the world of free enterprise and healthy competition. It’s good for the consumer. But the insurers are winning the fight and many docs are not able to provide this service for legal reasons. In fact, insurance companies are pressing state legislatures nationwide to impose regulations on these retainer fees that private docs charge. This must not be allowed. People need the care, so what if it means the private insurers have to work a little harder to compete with the docs. It’s about time we gave doctors the upper hand and more say in American healthcare.

So that’s it. That’s one doctor’s solution to our healthcare needs. It’s simple and relatively easy. But I’m not holding out any hope that Congress will do these things. It’s much easier for them to raise taxes through the roof and provide blanket coverage for everyone. Just remember what the late Gerald Ford said (pp): "What the government provides for us the government can also take away from us." Well said, Mr. President.

Continuing with yesterday’s commentary. Something that I feel is important to cover involves educating the general population on proper utilization of healthcare resources. Yes, we have a problem with uninsured in this country, but in many areas there are access problems, especially with lawsuits driving docs out of business or into less “sue-happy” locations. This creates a void in healthcare availability and strains the remaining resources. Not only that, but a large portion of expense comes from Emergency Room visits by people who don’t have primary care physicians or don’t have insurance. So our ERs are seeing simple things like colds and sinus infections, incurring great costs that often go unpaid and leading hospitals to pass the costs on to those who are insured. This is a big problem and part of the solution involves changing our way of thinking. So here we go:

It’s not always abnormal to be sick. Everyone has been sick. It comes with being human. Whether you’re talking about bronchitis, sinusitis, laryngitis, pharyngitis and in many cases otitis (ear infection), these are all things that we all obtain on multiple occasions throughout our lives. So, it’s not necessarily abnormal to be sick. In fact, I would say that it’s more abnormal to never be sick. Rarely, and I do mean rarely, do these things require the care of a physician. The vast majority will resolve on their own via our effective immune systems regardless of what one does to treat them. But that’s not the going opinion in the public. We seemed to have developed the mentality that sickness must not be allowed and must be treated immediately. It doesn’t matter that there is nothing the physician can do for these that can’t be done over the counter. What matters is that we don’t like to be sick and when we get sick we feel that sickness deserves attention. Hence, we go to the doctor. This isn’t necessary, and it’s extremely costly. I think society would do themselves a favor by learning that it’s best to leave the doctor’s office for people who aren’t just sick, but are REALLY sick. In the long run, it would benefit us all.

Pain is not unacceptable. This follows with the first point. We have all experienced pain. It’s also part of being human. Sometimes it’s an achy wrist, or a sore ankle, or a sore toe. Sometimes our hands hurt, our shoulders ache. Sometimes we get headaches. Sometimes we get back aches. This is all, arguably, part of a normal healthy human body. Pain is a defense mechanism, and when something like tendonitis or synovitis pops up, it’s the body’s way of telling us to take it easy on that wrist or that ankle until it heals. And it will heal. So why do we not tolerate pain? Again, there seems to be a mindset that any pain is unacceptable and must be eliminated right away. We no longer tolerate the minor aches that come with normal human activity. Again, this leads to unnecessary, expensive visits so the physician can tell us what our bodies are already trying to tell us…take it easy until it heals. But sometimes, patients are also told to take over the counter medications, which brings me to the next point.

Treat yourself first. We all know what to buy when we have a cold, or a headache, or an achy wrist. And if we don’t know, the local pharmacist will be glad to point us to the right aisle. Generally, an over the counter medicine will do the trick for that achy toe, or the nagging hemorrhoid, or the sore throat, or the occasional cough, and it will save a lot of money. Besides, do we really need a physician to tell us to take Advil or Nyquil?

An emergency is anything that poses an immediate threat to life, limb or eyesight. Unless directed by a physician or nurse, there is no other reason to go to the emergency room.

So we all need to learn how to properly utilize our health resources if we’re going to overcome the many problems that we face in today’s healthcare. The above suggestions may seem small, but if applied by millions the cost savings becomes substantial. On the flip side, until we all practice the proper behaviors, discussion of national health care or socialized medicine should be off the table. Right now, the only thing discouraged healthcare abuse is out of pocket cost for the patient. If we open the gates and provide free care for all…well, it would be fiscal suicide for the government. So let’s all learn the lessons. Tolerate that cold, it will go away within a few weeks. Tolerate that achy wrist, it will heal soon. Be your own doctor. Leave the ER for true emergencies. Maybe, if we cooperate, it will ease the burden on us all.


BB-Idaho said...

Your ideas are reasonable and workable. I assume you are basing them on work as a physician? As far as self-help, many of us (males, of course) avoid the Dr.
Mine calls me once a year and makes an appointment! My experience in self-diagnosis went awry back some 25 years ago: a persistant fever, ache and kidney
pain finally convinced me to see
my physician. I convinced him that I had a kidney infection and the requisite drugs were prescribed. After a month of worsening symptoms (I even missed a half day of work!) I returned..and was immedicately hospitalized with pneumonia. So,
"be your own doctor" has it's limits. Apparently we have socialized medicine here already, because I stood in line for an hour for a flu shot last week.
IMO, the current problem with healthcare is cost: we note a number of large companies seeking
government intervention. Since my part D prescription rose 71% this year, I'm with a majority that seek
change..I can put up with private
health, but am worried about my
children and grandchildren. The
system is bloated and out of control.

John Washburn said...

BB, yes there are limits to self care. Thank you for sharing your story. And of course our current system is not flawless. There is room for improvement, but government takeover is the absolute wrong way to go. There is no example of effective government driven health care elsewhere on this planet, and since when has the government EVER been able to save costs and improve quality over the private sector in anything.

If we devolve into socialized medicine, costs will skyrocket. You think health care is expensive now? Just wait until it's free! Not only that, but access will plummet. That nasty case of pneumonia you had...you won't have to worry about seeing your doctor for it because there won't be an appointment available for you. Ever see the line at the post office? Multiply that on a grander scale and put it in your doctor's office. That's what will become of government funded health care.

Solving this problem requires reform of the current system, not a complete overhaul. We STILL have the best health care in the world. And we are one of the few countries that keeps its health care privatized. Certainly there is a connection there.

Thanks for your comment.

The Loop Garoo Kid said...


Thanks for reprinting the post. I find myself in complete agreement w/ you except on two points.

The first is the myth that trial lawyers need to reigned in. The excesses of our our profession are largely exaggerated but if you wish to discover the real culprit, you have already identified it: the insurance industry.

Physicians who abondoned fields of practice or practcing in certain states do so b/c of the cost of malpractice premiums. The insurance indusrty, not trial attorneys, set those premiums. The only thing insurance companies care about is making money. Trust me on this one. I have done defense work. I have been staff counsel for a major insurance company.

I will not cite chapter and verse regarding how difficult and expensive it is to bring a successful medical malpractice case in the state of my residence, Colorado. Let me just say that as an attorney, if you take on one of these cases, be prepared to spend $100K of your own money to do so and be prepared to try the case. As a rule, these cases do not settle in Colorado. First you need to obtain the opinion of a physician who practices in the same discipline as the one against whom you are bringing the claim that the claim does not lack sunstantial justification. Also, there are damage caps.

Instead, let us look to Texas which several years ago passed sweeping legislation governing medical malpractice cases. The not-so-funny result: medical malpractice premiums have not been lowered.

For the last quarter century the insurance industry has waged a largely successful propaganda war to deny justice to people who are injured as a result of the acts or omissions of other individuals or corporations.

If you wish to see obscene compensation for executives, look to that of insurance executives only you won't be able to find it for Sate Farm and a few other companies which are privately held.

The second point w/ which I disagree is your perception between corporate taxation and the abilty of corporations to offer healthcare. Outsourcing and the shift of jobs overseas has little to do w/ corporate taxation although some corporations have relocated to places like Dubai for tax purposes. Outsourcing and the shift of jobs overseas is related primarily to labor costs.

The unwillingness or inability of companies to offer healthcare is related to the expense of offering health insurance.

Thanks again. Regards.

Md Elite said...

Lawrence R. Brownlee, MD - Tustin, Orange County, California - started a concierge medical practice at the request of some of his patients. all is well after three years.