Health Care Change -- Let's Get Specific

The Democratic health care debate has focused almost exclusively on whether 15 million people will purchase health insurance on their own. That debate is important, but where is the quality debate? Why would 15 million people trying to make ends meet buy health insurance if they aren't likely to receive the attention they need? What good is mandating insurance coverage if we don't also insist that it lead to improving and saving lives no matter the socioeconomic status of patients?

I've spent my career studying what elicits change. My first book, Persuasion In Practice, described as "a landmark contribution to the field" by Public Opinion Quarterly, focused exclusively on why and how people change. It's not a fast read as it analyzes decades of theory and research -- great for academics and insomniacs -- so let me abridge.

We're creatures of habit. Even bad habits can become old friends. We know what we should have had for breakfast this morning, the amount of exercise we should have undertaken by this time of day, and what stress-reducing efforts should have been employed to assure good health now and in the future. But often we simply can't do what we should. Events transpire to preclude following our best intentions. And so our health suffers. I've learned from years as both a National Cancer Institute Fellow and preventive medicine professor that people don't do what they should do so much as what they can do given constraints on their lives. Attempts at improving health care must address this challenge. How do we make what people should do something they can do as well?

Then there is the problem of doctors knowing what they should do to help patients but being all too aware of what they can't do given time constraints and lowered quality standards of care. The result is approximately 100,000 hospital deaths from medical errors each year, hospitals rife with deadly bacteria, and patients thinking they know what their doctors advised but not being sure.

Even if you have a doctor who is knowledgeable and willing to provide the time you need, errors happen further down the line. USA Today described pressure on pharmacists to fill hundreds of prescriptions a day, often without taking time to talk to customers about dangers. They featured a little boy accidentally given a steroid that could damage his liver and stunt his growth. Much worse would have happened had the error gone unnoticed.

Which candidate is going to show us that he or she truly understands not only the need to pay for medical care but also the need to assure competent, compassionate delivery? Those are two of the brass tacks of medical care important to those with insurance and those as yet without. It's great to be able to pay for health care; it's even better to be able to live long enough to do so.

It's time to hear more from the candidates about quality of health care. This is a life or death matter from infancy to advanced age. How will patients be educated to ensure they know what to expect, what responsibilities they must assume, how to provide doctors and medical professionals with specific, critical information, and also how to locate outstanding providers? What will we do to educate medical students so that communication with patients is every bit as important as identifying their ailments? As we add more insured patients to an already overtaxed system, what steps must be taken to enhance quality of medical care? Where along the chain of health care delivery will the government exert pressure so that errors are substantially reduced, hospitals are not breeding grounds for deadly bacteria, and preventive care is made readily accessible?

How do we avoid a health care blame system, implied in presidential candidate plans, where those with chronic diseases are viewed as economic drains on a taxed system and perhaps considered victims of their own errors and negligence by those who argue that such illnesses are preventable? Some are and some aren't. Life is full of sharp curves, and sometimes you just don't see one coming. Sometimes, to mix metaphors, your number simply comes up.

These are only a few questions of critical importance to the future of health care in the U.S. Who is covered is important. What that means in terms of quality is the more challenging question -- one which presidential candidates should address with specifics that assure all voters. Because one day, not necessarily in old age, each of us will find ourselves fighting for our lives.

Comments

[longislandlol]

Michael Moore should be appointed the Healthcare Czar of our great nation-- next-- bring over the socialist medical experts in from England and other lands-- we cannot pretend to be the know-it-alls- we can learn from other successful systems..

[JimR]

The reality is, any president's health-care plan is going to have to be approved by Congress. Given all the lobbyists in D.C., it's highly unlikely that any plan coming out of Congress will look very much like the one that went in.

[Dap]

Dear Dr. Reardon,

That's why I heart ya SOoooooooo much, what a wonderfully sound essay/post. Ya hit the nail on the head. As I see it, it's the middle men that have driven our health care system into the ground, avarice plain and simple... Senator Bill Frist and his money grabing ilk.

Make no mistake about it. Agape.

[kirotahoe]

so i had a health problem and i needed to see a specialist. i called my insurance co. and they said go ahead and then send in a claim. so i did, and the claim was denied. i challenged and lost. so what difference between me and an uninsured patient? i'm out $300 a month for a premium. this was in funny times but illustrates one sad fact about our health care. we must get money out of the equation. as long as doctors are concerned with seeing as many patients as possible to maximize their income, we will not recieve their complete attention in their office. i have had doctors ask what medicine i am taking when they put me on it and my chart is is his hand. i believe doctors are basically sincere on their wish to help patients, but the system forces them to hurry. not all, as some are just greedy bastards. and health insurers make their profits by denying coverage. and only insuring people who are young and healthy. then there are the drug companies who make americans pay exorbitant prices to subsidize other countries where they cannot sell their medicine for so much. i recently wanted to take nexium til i found out it cost four hundred for a month. how many millions take nexium and why does it cost so much, when you can buy zantac,(basically the same) over the counter for ten bucks? the complete system must change to single payer if we are ever to have a competent system. when doctors can no longer get rich, only people who care about helping people will be doctors.

[ReasonIsMyReligion]

A few years ago, I read about an approach in Oregon that was laudable.

A panel of doctors and financial types put together a list in priority order, with prices, with number of people affected, of addressing the gamut of medical issues.

Then they said to the state: "When you tell us how much money you can kick in, here's where the line will be drawn."

Ferrexample:
(pardon the lack of tabs):
1) Childhood Immunization, 400k kids, $1M
2) Setting broken bones, 100k people, $50M
3) Heart Transplants, 10k people, $30M

You got $81M? We're golden. But we might have to raise taxes.
You got $51M? Sorry, no STATE-funded transplants.
You got $1M? Immunize the kids, and that's it.

Again, made up example numbers. But the idea is easy: We need to maximize bang-for-the-buck and do the best-value things first.

Should things cost what they cost? Not in my book, but that's a different topic.

[Wulfstan]

Why are none of the candidates proposing Medicare for all ?

[TXfemmom]

I was a health care professional for 26 years and the care has deteriorated in the last ten years. I have had failure to convery the correct information, the total information, incorrect prescriptions issued, a hospital try to convince me to sign an operative permit which was for the wrong side, and a physician covering for one of mine who ignored me, while I was in the hospital for nearly twenty four hours and I almost died.

If this can happen to a person who is informed, diligent, motivated, and concise, and a medical professional, just imagine what happens to others.

We need to begin to look at health care as they do in France, that it is a credit to work in health care, that all deserve it as a basic human right, that all must contribute to the cost of it, and that the care must be exemplary, and not just greed driven.

[ProudNeoCon]

you consider the health care in France "exemplary"? LOL

[ReasonIsMyReligion]

You think we're getting good value? LOL