People keep asking me what type of health care system I would support.  With some type of health care reform bill soon likely upon us, I suppose it is a timely question.  I hear many others in support of everything from the “do nothing” plan to full fledged socialized medicine.  I don’t know that either one is the answer, but then again, I’m not sure that I have the answer either.

I do know a few things that I see in my own practice.  The first is that physicians across the board over utilize health care resources.  It’s rare to find a physician who has been in practice for any length of time who has not been sued for some supposed act of omission.  When things go wrong, people need someone to blame—and to pay.  So when a patient comes into my office with hip or knee pain and no clear explanation, in spite of the fact that we all have hip or knee pain at some point, more commonly as we age—I order an MRI scan—even though I am 99% confident that it will not show anything of significance.  Sometimes the patient demands it!  There goes $1,000 for another test.  More often than not, the MRI shows some little this or that, but nothing that common sense wouldn’t have told me to treat with activity modification, anti-inflammatories and the usual gamut of conservative measures.

Physicians live in fear of malpractice lawsuits.  Lawyers have made it so easy for patients to file frivolous claims—and threaten not only to trigger an increase in our malpractice premiums, but threaten to exceed our malpractice limits thereby gaining access to personal assets.  With a legal system that makes lawsuits so easy, why not minimize the threat by ordering a test that doesn’t cost us anything—and usually doesn’t cost the patient either? So first, meaningful tort reform is necessary to control healthcare costs.

Second, private insurance companies, I suppose, are the epitome of capitalism in action.  They are businesses whose primary goal is to make a profit for themselves, not care for patients’ health.  But when insurers are allowed to fix prices where they want and make delivery of effective healthcare difficult in order to generate profits for themselves and their stockholders, healthcare suffers.  As much as I believe that capitalism is the key to a thriving economy, something has to be done about insurance companies that put profit before provision of affordable healthcare.

Socialized medicine?  Not so much.  There are so many things wrong with so many government-run bureaucracies that putting more programs into their hands is the last things we want.  Not only will government restrict and ration healthcare to a level not before seen in this country, but the delivery will become even more inefficient and costly.  Look at the per capita healthcare costs vs healthcare services citizens receive in countries that have socialized medicine.  It’s outrageous.  Yes, it all works great—until one gets sick!

So, yes, I do believe that we should have a safety net for all those who cannot get or afford healthcare.  Private insurance companies should not be allowed to profit at the expense of the health of our citizens.  But don’t throw out the baby with the bathwater.  Help physicians take care of patients without the hindrance if insurance companies or government.  And help patients needing care get it.  Control frivolous lawsuits.  And minimize bureaucracy.  Those changes will give us a good start.  And could we do it without that panic that it has to be done “yesterday”—so that we can take time to study the effects of these changes and make rational decisions?  I hope so.

Posted via web from Todd's posterous