Campaign 2008: Preventive Medicine
Any health plan, public or private, government-sponsored or not, needs to cover preventive services. Hillary Clinton quotes these statistics: "Only half of recommended clinical preventive services are provided to adults and less than half of adults had their doctors provide them advice on weight, nutrition, or exercise."
This should be a wake-up call to everyone affected. The disparity in the level of professionalism of doctors is something that needs to be addressed. The hope is that with increased competition caused by the implementation of new health care choices for Americans, doctors will change their tune and work harder to give patients the best possible treatment.
Will this happen? I don't think so, and that's why we need a plan for preventive medicine that addresses this issue, possibly one that rewards doctors for following "best practices" medicine. As I've stated in one of my blog entries, I was seeing a doctor on Staten Island I'll call Dr. Fox, who failed to tell me I was at the highest risk for heart disease, even though it was clearly indicated on my blood test results. I saw him for five years without this issue ever being addressed. It was only when I wrote to him asking for copies of my blood work, and played detective, that I realized something was wrong.
When I switched to Dr. Krall after moving to Brooklyn, she began to schedule me for blood tests every three months. And just three weeks ago, she had The Conversation: about how I had to exercise at least four times a week, for a minimum of thirty-five minutes each session, with a mix of cardio and strength training, not just the treadmill.
I'm the lucky one; others aren't so fortunate. And while this blog entry talks about preventive medicine, I'll here now detail my experiences with various health plans over the years. Before the advent of managed care, before I had to choose a primary care doctor, I would only go to the doctor when I got sick.
At my first job when I was twenty-five, I had a raw throat and looked in the provider directory to choose a doctor. When I showed up at her office, her medical assistant didn't speak English, and to inquire if I needed blood work, she jabbed her arm with her index finger. "No, no," I waved my hands back and forth in front of me.
When the doctor did see me, she gave me a free sample of a 1,000 mg. anti-biotic, as well as a prescription for an anti-biotic. Afraid of a toxic overdose, I asked the pharmacist if it was maybe a bit much to be on such a high dose, and he confirmed my fears.
Not only that, the doctor wouldn't take the required co-pay and instead billed the insurance plan for $125 dollars for the five-minute visit, which they gladly paid, yet this and other health plans I've had would only reimburse my psychiatrist $35 for a visit. Such discrimination in coverage between mental and physical health care no doubt contributes to the stigma that we are lesser people for needing to go to such doctors, and that our treatment isn't worth paying these doctors what they're worth. No wonder a lot of psychiatrists opt out of HMOs and managed care, instead, billing patients directly and at a higher cost.
The best thing about having a primary care doctor is that you have a point person to co-ordinate your services, and someone you develop a relationship with over time. When I needed to get the flu shot in October and was afraid of the pain, Dr. Krall said, "I wouldn't hurt my babies." That was a noble bedside tactic. Perhaps a person could be a good doctor and not have a winning way, though. I'm not certain this is true. She and Dr. Fox were the only doctors I saw for the long-term, and he treated me as if I were only the next patient in a long line of patients. Oddly, there was never anyone else in the waiting room when I went to see him, and Dr. Krall's office is bustling.
Here's the rub: if someone is a member of an at-risk population, doesn't it make sense to do preventive medicine with him or her? I'm certain this is where all the libertarians get on my case and advocate for the free choice to decide for yourself if you want to seek help for your condition, that health care shouldn't be legislated or forced on someone.
I beg to differ. One thing I know: primary care doctors need to do a better job of giving simple tests that can determine if someone is at risk. Dr. Krall regularly monitors my cholesterol, sugar, liver, kidneys, heart and thyroid. There is no excuse for a doctor not practicing preventive medicine.
In all this talk about proactive medical treatment, we need to remember "preventive services" must include things such as depression screening, and services for at-risk populations for schizophrenia and other mental illnesses. According to the National Alliance on Mental Illness, it's estimated that untreated mental illnesses cost the U.S. more than $100 billion per year. Mental health parity has been an elusive goal for over ten years, and if a federal law isn't passed this year, I will vote only for the candidate whose platform includes signing such a bill into law.
Otherwise, what chance do we have to truly treat our mental illnesses, if the president keeps sweeping our efforts under the rug? I know who I'm voting for and I prefer to keep that private, yet I will say that each of us does need to hold whoever wins, accountable for his or her actions, and accountable for the health (and mental health) of the nation.
Will providing best practices medicine increase the cost to patients, health insurance carriers and others? Perhaps, but it's a risk I'd be willing to take. When it comes to my mental and physical well-being, I'd gladly pay extra.
In Campaign 2008, not one candidate resists or nixes the clarion call of preventive health care. Bring it on! It's an idea whose time has come.