It could happen. War costs to assuage our never-ending lust for domination, energy dependence, environmental catastrophe, an out-of-control deficit and soaring social needs might signal the end of America as we know it. However, as serious as those issues are, health care could be the item that finally tips the scale. Faced with the ever-growing need for medical attention and an aging population, coupled with America’s staunch reliance on capitalism and exceptionalism, medical care could cause our actual downfall.
From medical education to the research and development of new drug therapies to the invention of innovative health technology and care, America must reduce their expectations to a more realistic level. The question must be asked, “How can we pay for a champagne plan of medical care on a beer budget?” Privatization is only part of the answer, oftentimes used as just a method to kick the can down the road. To initiate and put into practice a health care system as vast as ours is requires a federal structure on the provider side, not that that would guarantee against corruption, unequal access and price gauging, which flourishes in just about all of our other private industries. On the consumer side, patients can expect the best care possible, those treatments and procedures that are cutting-edge, AS LONG AS THEY PAY FOR IT. No one would deny them the care they expect. They just have to pay for that Cadillac program of health care if that is what they so desire.
A little bit of history and perspective is needed. About 20 to 30 years ago, managed care became the salvo for delivering adequate, cost-controlled health care. The minute I heard that doctors were to be referred to as “health care providers”, I knew our gooses were cooked. The thought behind that new labeling was that the term “health care provider” would take the once cherished relationship element out of the doctor/patient encounter, thus reducing our health care experiences to just another aspect of American consumerism. The insurance companies believed that by de-personalizing our patient/doctor visits, our costs would somehow decrease. And as long as the costs were kept affordable, Americans had no problem with this downgrade in their health care. So what if every time they visited their physician they were examined by a different doctor. So what if there was no continuity of care. Just the fact that their insurance premiums were kept low while getting to see a health care provider seemed sufficient. Everything was just hunky-dory —- until perhaps they got really sick and they expected a higher standard of care. Then, the doctor du jour did not seem so acceptable. That is when the patient wants their physician, not their health care provider.
Furthermore, the current proposed policy, that of requiring electronic medical records, is likewise just an attempt to further de-personalize health care. Sure, the supposed reason behind this is to make health care safer for all of us. Hogwash. This system would enable any health care provider to supposedly step in and assume the delivery of care. Since the patient’s history is so neatly electronically available, there would be less talking necessary during the visit and thus, less fees would accrue. However, I daresay that there would also be less attention to personal details which could result in poorer medical treatment. Also this electronic charting would enable employers, insurance companies and other capitalistic entities to have access to personal medical records. And we have already seen the lack of privacy rampant in computer record-keeping. It is very important for the patient to make clear, if they care enough to do so, that when they visit a doctor, they are hiring that particular doctor for one’s care, not the entire practice. Old fashioned? Perhaps. Yet it is still the one basic thing a patient can do to ensure some quality control.
HMO’s, PPO’s and every other combination and permutation of health services came to the forefront of health delivery systems claiming to keep costs down all the while making preventive care and exceptional sick-care the cornerstones of American health care. Medicare and Medicaid developed fee systems based on total care, rather than each individual item or procedure of care. Slowly but surely, doubts arose as to the true availability and standards of care delivered, influenced by the principles of capitalism on one hand and the rights of entitlement and expectations on the other hand. Managed care came to satisfy no one, not the insurance companies touting its benefits nor the patients who subscribed to those plans. Thus, through the ensuing years, the controversy continues to flame the debate on cost versus decent and the expected state-of-the-art care.
Paul Krugman wrote an Op-Ed yesterday on consumerism in American health care. Read it carefully and then proceed.
Medical tuition today can top out over $250,000, and that is just for the costs of medical school, not including college. Prospective physicians are beginning their careers with a crushing amount of debt. Once they are out of school and into practice, third-party payers determine reimbursement rates. Capitalism and consumerism have no place in medicine: unregulated fees for services rendered will break our system, yet the regulation of fees will likewise kill our patients. Perhaps one answer is that if medical fees are going to be regulated by the government, the costs of educating our doctors should be backed, or at least subsidized, by those third-party entities. If our goal is to strictly regulate the health care fee structure, the entire system should be equally integrated with that goal in mind, and it should start with helping future doctors pay for their education.
Drug research and development concerns are also faced with the dilemma of costs versus innovation. Bringing a new drug to market is an enormously expensive venture. The research, the regulatory process and the government rules for repetitive effectiveness and safety testing is a cash cow for billions of dollars. Finally, when a drug is approved and sent to market, should there be controls on the cost of that medicine for the benefit of those that need it? If so, how will the drug companies make back their investment and stay afloat? If they are not permitted to recuperate their investment, they will no longer work on new drugs. Working for the greater good has its benefits, but in the end, who will pay the bills? If you think this process is unfair for those drugs that could possibly help millions of people, think about the orphan drugs which are just as important yet have a very small market share. People with very rare diseases, who are screaming for a drug solution, must consider the huge costs associated with a cure. The expectation that the need has priority over the cost of development is, quite frankly, unrealistic.
Medical technology and care also face the same obstacles. The costs of inventing and producing new scanners, treatments and protocols are extremely cost-intensive. Then, should our general policy be that just because we have it, everyone should be entitled to it? It goes without saying that corruption, greed and good old American capitalism rule the health and insurance industry just as they do all of our other enterprises. That said, Americans still need to make their own provisions and take personal responsibility for their expectations of medical care.
Krugman was correct when he wrote that there is not much room for consumerism in health care but at the same time, we have to start saying “No.” Americans should have access to the best medical care, but they are also going to have to pay for it. The time for entitlements is over. Additionally, 40% of our Medicare dollars goes towards care in the last month of life. Call it “death panels” or call it “rationing”: something’s got to give. American health care cannot be everything to everybody. Until we can design and implement a fully integrated system, encompassing prevention, treatment, malpractice reform, fair reimbursement, responsible drug costs, and helping out with medical tuition, our health care program will be simply another band-aid on a festering wound.
My stand on health care might be considered brutal by some. I am all for everyone having access to the best medical care that exists. Truly I am. However, those people should be aware of the costs involved and should be prepared to pay for the coverage and treatments. There should be a decent level of health care for available to all of us. Then, for those who want to cover all of their bases, additional plans should be purchased. Americans might have to forgo that big screen television or that late-model, shiny, new car for an investment in their future health care needs. If we persist in applying capitalistic principles to health care along with consumerism to the patients, then the chips will have to fall where they may.
On a lighter note, The Onion had a great article on Romney and medical care: