Friday, March 07, 2008

It's Time to Reform Health Care

Health care costs in the United States are spiraling out of control. A recent study indicated that these costs could absorb 20-25% of the gross national product (GNP) in just a few years. There is no way America can remain competitive if so much of our economy is devoted to keeping us healthy. However, I contend that a significant percentage of current health care spending is unnecessary and ill-advised. We need a major revision in our thinking about health care, and government must provide us with the facts and a plan for change.

During my working years I seldom thought about health care. We had a healthy family, and our only contacts with the system were regular doctor visits and a few "emergencies", such as when one of my sons broke his neck playing football. The health care system met our needs, and my company paid most of the cost. But now I have a much different outlook.

Since 1999 I've worked at a local volunteer ambulance corps, primarily as an EMT "medic" on the ambulance. In this role I've seen thousands of people enter the health care system for a wide variety of symptoms - traumatic injuries, cardiac and respiratory issues, seizures, strokes, common internal disorders such as kidney stones, the "flu", psycological disorders, and others. Many of these people clearly need qualified medical assessments and treatments, but many others require other types of non-hospital care that can be much less expensive, more effective, and better for the patient.

The three most important opportunities for non-hospital care involve preventive care, end of life care, and specialized care for common disorders such as diabetes, alcoholism and psychological/behavioral issues. Far too many emergency room cases relate to these types of issues - issues that emergency rooms and hospitals are not designed to deal with, that clog the system and hinder care for those with true emergencies, and cost us huge sums when treated there.

Perhaps the best example of an opportunity for preventive care is obesity. Those who are significantly overweight experience a wide variety of symptoms that relate directly to their weight. They have musculo-skeletal problems that create a need for hip and knee replacements, they are likely to contract diabetes, and they are at far greater risk for cardiac and respiratory problems. We need incentives that encourage people to not become obese, such as higher insurance costs, prohibitions of certain insurance-covered treatments for those who have not controlled their weight after being diagnosed with obesity, and large co-payments for specialized equipment like motorized chairs that mitigate some negative aspects of living with obesity. These incentives would save huge costs while actually improving the lives of those who have this problem.

End of life care is a disaster in our country. We seem to believe that death can be avoided simply by performing more and more medical interventions, even though we all know this is not true. The health care system needs a process whereby aged persons with certain chronic conditions, or those with confirmed terminal illnesses, go to hospice rather than hospital. Doctors can and should make these diagnoses. However, in today's world both patients and their families are often in denial of the futility of the situation they face. The result is ineffective, costly, and often gruesome medical treatment for those whose near-term demise is certain.

Finally, we need specialized care centers for those with common chronic diseases like diabetes, asthma, alcoholism and drug addiction, and psychological disorders. These conditions can be life-threatening, but paramedics can stabilize most patients with diabetic issues and asthma, and emergency rooms have little capability to deal with addiction or psychological problems. Most of these patients could be diverted to specialized care centers that would be more effective and less expensive.

I've not spent any words describing specific cases that support the recommendations outlined above. In my view, these conclusions are obvious to most health care professionals, and anyone who spent a few months riding on an ambulance would come to the same or similar answers. What is needed is for our governmental agencies to generate the facts, communicate them to Americans, and enact new laws that will reduce overall health care spending and improve outcomes. The fact that they are not doing this means that politicians are not addressing matters that truly are of great national interest. All of us need to recognize this and elevate the issue to those who have the power to fix it. Or, we can go bankrupt by keeping the disfunctional process that has evolved over the past half century.


ThomasLB said...

I really think a national health care system would pay for itself, particularly if it had a strong emphasis on preventive care. It's cheaper to give away a flu shot than to treat pneumonia.

Dave said...

What's your view on "overtesting" by physicians to ward off malpractice and the cost of the infrastructure of medicine?

1138 said...

It's time to take some of the FOR PROFIT back out of the health care INDUSTRY.

Remember, if you try hard that there was a time, not so long ago in out life times when it was not an INDUSTRY, it was a service.
Doctors were good men, not rich men, hospitals and test facilities were not revenue centers.

Health care is broken, but not just because we are sick - but because health care is sick.

Lifehiker said...

Technology has changed medicine. It used to be mostly about a doctor and a patient. Now it's about specialists and fantastic equipment and drugs - it is an industry whether we like it or not.

The benefit is that many sick or injured people can now be cured or fixed when, in the past, they could not.

The problem is that we have a "one size fits all" system where the same rules and processes apply no matter what.

I heard today of a 53 year old cocaine addict who regularly gets chest pain as a result of his drug use. He also has a permanently high reading on one cardiac-related test. Even though everyone knows his pain is cocaine-related, this one reading makes it necessary for malpractice reasons to admit this jerk to the cardiology ward for five days every time he comes in. He's come in 25 times in the past two years, and we've paid probably a million dollars to give him care he doesn't need. Go figure.