09/03/2009 03:53 pm ET | Updated May 25, 2011

Four Health Care Reform Issues We Are Ignoring

Our current system of health care leaves 47 million Americans without insurance. Some of these people are recent college graduates who tend to be healthy but may still encounter high health costs if they break a leg or are in a car accident; others are working people who still can't afford health coverage and are vulnerable to all the accidents and illnesses that can befall any family. These people will eventually be seen by doctors if they get ill, but it will be in a hospital emergency room.

As a health and medical writer, here are four issues that are not always clearly explained when the potential changes in our health care system are discussed.

No one is well served when "garden variety" ailments must be addressed in an emergency room. There are three serious problems with this:

  • People who don't feel well but are not experiencing a health crisis clog up the emergency rooms and take the time of specially trained emergency personnel who need to be available to deal with true emergencies like strokes and heart attacks. People who aren't feeling well should have medical care, but it should be provided in an office or clinic setting, not in an ER, which is the most expensive setting for cure.
  • Unbeknownst to most people, we all pay for this type of walk-in "charity care." The uninsured person who comes to the hospital emergency room will be taken care of, but hospitals are not donating their services. They keep track of the numbers of people they see, and at the end of the year, each hospital will receive a proportionate payment from various state and federal agencies like the Hospital Indigent Care Pool in New York. Ultimately, we all pay for that care through our federal and state taxes.
  • If preventive care were available to more people, it could stave off many emergencies. Doctors say that a fraction of the children with asthma would be in emergency rooms if they were receiving appropriate medication regularly. Or consider an illness like diabetes. If the patient receives regular medical care, the cost of the disease involves regular medical visits and insulin injections. If the disease is not properly managed, the patient may require an amputation and rehabilitation in order to save his or her life. Wouldn't we rather establish a system that permits a diabetic to get insulin treatment than pay the bill when he has to have his foot amputated?

Anyone could find himself without insurance in our current system. Reform will improve this situation. Today fewer employers are offering full health benefits, and if you change jobs or are fired under our current system, your insurance ends shortly after your employment does. COBRA can be used to cover an interim period, but what if there's no "next job" in the span of time permitted for using COBRA? And anyone -- wealthy or poor, young or old -- with a pre-existing condition may find himself denied coverage, or if insurance is available, it is extremely costly.

Each patient should have the tests and the medications that are effective for his illness -- not the one the person read about on the Internet.
Some people complain "they want what they want" when it comes to diagnostic tests. Professor Archie Cochrane (1908-1988), a Briton, was the first person to advocate for evidence-based medicine. In the 1970s Cochrane wrote a book that espoused the need for a clear system to evaluate a condition. He recommended statistical reports on treatments to determine what method of cure is best suited for each particular patient. Of course, the person reading the statistics would be one's physician who could modify as he saw fit. What's wrong with providing a physician with the most helpful data and letting him decide which care is best?

Many diagnostic tests are not only costly but they are not risk-free. One physician recently noted that since actress Natasha Richardson's death after hitting her head on a ski slope, everyone with a bump on his head wants a CAT scan. To expose a patient to needless radiation as well as the potential side effects from the iodine-based contrast solution (used prior to a CAT scan) just because the patient is worried he might suffer Natasha's fate is flawed thinking. Your physician needs to balance the risk of a test with the reward of what might be learned. The teachable moment from Richardson's case is that if the ski patrol suggests someone be medically evaluated, then that person should see a doctor as soon as possible. It was the actress' decision to return to her hotel room that was the fatal mistake -- not the lack of a CAT scan.

Costs need to be restrained via a "public option." In all of the discussions about health care reform, everyone agrees that we need a method to rein in costs. The best hope we have for this is adding a "public option" -- an expanded version of the well-liked Medicare program. The public insurance option provides marketplace competition on both drugs and services, and it might successfully help bring down costs.

Early in our nation's history, education was not guaranteed for all, and now we wouldn't think of not providing schooling for all American children. The same should be true for health care.

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