What Does HealthCare Reform Mean for You?
Our politicians and the insurance companies can't seem to get certain things right about health care. Perhaps it is time for us to act like "we the people" and let them know what we need and want, and make them discuss it during the campaign. Don't you get tired of 30 second "sound bytes"? I know that I do.
It is standard in business and elsewhere to do a cost-benefit analysis, yet we seem to do only a cost analysis without considering the "benefits" in the current election cycle. It's hard to cut through the arguments to know what really matters. Each party criticizes the other party's ideas for health care reform as costing too much.
It is time to demand that politicians address the issues that matter. Here are some important ones, in no short order.
- Healthcare expenditures: What is the breakpoint? If total cost of healthcare is equal to the salaries of the physician, ancillary staff, laboratory tests, procedure related costs, equipment, hospitals, rehab centers, nursing homes and medicines, and total money available is a percentage of the gross national product, which is relatively fixed, then how can we reasonably decide to only control physician reimbursement while permitting the other costs to rise?
- Should we award hospitals a premium to be the hub of the health care system? After all, 99% of medical care takes place outside of the hospital. We need to be honest and ask ourselves whether a hospital that looks like the Ritz Carlton and has a huge endowment gives better medical care to the average American then one that spends its money on nurses and looks like a Holiday Inn.
- Although they call themselves non-profits, the CEOs and boards of trustees of hospitals seem to obtain rewards far beyond their actual input. Who is looking into the regulation of non-profits and whether such regulation is for the benefit of the people and area served?
- Should we award insurance companies a premium to be the hub of the healthcare system? These are for-profit agencies that often make decisions on the basis of what is good for their shareholders, or what can be sold to the public. These are interstate commerce and the sale of their products should be regulated to protect the consumer of health care.
- And what about "therapy sessions" by a licensed professional OT, PT, RT etc? Can we demonstrate that provision of such services decreases mortality, morbidity or changes prognosis? If they don't, should we continue paying for them?
- When diagnosing a medical condition, how many tests are enough? How many are too many? If a chest X-ray or CT scan is not cost effective for looking for fatal infectious diseases, like TB, or for looking for cancers, how can we decide that a bone density test is cost effective for the diagnosis of the pre-disease osteopenia or osteoporosis? How much is a medicine worth to prevent osteoporosis? How many millions do we pay to prevent one fracture?
- Can we afford to pay for imaging tests just because they show "better" pictures? Shouldn't we demand proof that a "new" device or treatment is better and more cost effective than the other available options?
- When is a biomarker a necessary test that must be paid for by insurers? More important, should this decision be made by Congress, the President, the FDA, or the insurance industry (all consider the economic pressures of industry and other political pressure groups) or by a more appropriate body that understands the needs of the population (the costs to a patient and society are multiple if a test is sensitive thus detecting problems early, but not specific, thus making non problems into new problems).
- "Hospitalist" an old concept, reborn. While the use of a hospitalist system may increase the standardization and efficiency of care within the hospital, it may degrade medical care. Doctors that don't take care of sick hospitalized patients may be more efficient in the office, but may lose the skills needed to take care of acute problems. Patients that do not get to see their doctors in the hospitals do not get their chronic problems addressed. Who is looking into this?
- Why is federal health insurance different from state or corporate insurance? To the best of my knowledge the constitution was not written to create a royal class. Elected officials are still citizens. Is there a benefit for this country to permit 300 insurers writing 5000 different policies for health care with different rates and therefore creating different classes of citizens?
- If the practice of medicine represents an interstate commerce that can be regulated, why isn't insurance? Oh yes, the insurance industry has lots of lobbying power. Perhaps it is time for that insurers recall that the purpose of the industry is to provide a product that provides a service to the community. Investment houses and holding companies do not deserve the protection of "nonprofit" status; shareholders should not expect and do not deserve profits based upon federal support or subsidy.
- What about regulating drug pricing. I learned a valuable lesson 20 years ago when I had to buy an ointment for one of my children in France. It only cost $5.00. For the same treatment (same lot number, made in Ireland by the same American company), it cost $15.00 in the USA! I asked the French pharmacist about the difference. He explained to me that the company had been told by the French government to lower the price or the drug would not be covered in France. So they lowered the price, raised it in the US to make up the difference. An important lesson for our country to learn.
- For approval of the manufacture and marketing of a drug by the FDA we use a rather minimal standard requirement. Does this regulation regime work and is it safe over the term that it has been tested. Payment for the use of a drug should require more than a minimal standard by government programs. There is insufficient money in the system to pay for a $100 aspirin tablet. The standard should require that any new drug adds substantial value to the system, either by replacing more expensive therapies or by improving outcomes.
- We should reconsider the issue of direct to consumer advertising of prescription drugs. The drug companies take unfair advantage of the inadequately educated consumer to sell their products. Yes, it is important for the population to know that there are medicines or products that may help or hurt a particular condition, but it is rare that it is necessary for the consumer to know it before the physicians. I am probably as up to date as most of my colleagues, but I consistently hear of new drugs and products from my patients. I turned on the news the other night and joined the rest of the country in being bombarded by advertisements for prescription medications for urinating too often, difficulty sleeping, moving bowels too little, moving bowels too much, overeating and excess gas just to name a few, and all in a 15 minute segment. Please don't tell me that this is public education on the evening news. And note: not a single one of these products has been demonstrated to have mortality or morbidity benefits.
- Here's my parting thought: We do not have the best healthcare in the world if we have people who do not have healthcare. If 50 million people do not have insurance and 50 million can't afford their medicines unless they go hungry, then one third of our citizens might as well live in a third world country with barbed wire around a Ritz Carlton health care system.