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Maggie Kozel, M.D. Headshot

A Doctor's Advice: Take Three Questions and Call Me in the Morning

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WINNIPEG HEALTH CARE
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Healthcare reform is a complicated subject to tackle, and unfortunately too many of our politicos and pundits hold on to their jobs by making us believe that we are a house divided: people who hate the poor vs. people who hate freedom. But we know these are false divisions. Health care is a basic human need that we all understand and care deeply about, and we are not a people lacking in compassion. We are also frustrated that we have the most expensive health care system in the world, with some unimpressive results.That is why, complicated subject or not, the American public needs to drown out the din and work towards a meaningful understanding of the fundamental issues at play here. We need to raise the level of conversation, and demand that our elected officials do the same. Otherwise, foolishness and misinformation will carry the day, and we the people will be the big losers.

Even health care professionals and policy wonks find it hard to stay ahead of all the ideas and arguments floating around healthcare these days; all the more reason to focus on the fundamentals. Having spent twenty years in clinical practice, and the better part of a decade writing about health care, I would suggest that there are a few essential issues we all need some familiarity with if we are to have productive conversations:

1. Most physicians would agree that primary care and preventive services are at the center of sustainable, effective healthcare. Do you understand why that is? Do you understand why many experts feel that investment in primary care will save us money in the long run? Are you aware of the current economic disincentives currently exerted on primary care providers, and that we are facing a serious provider shortage? What effect do you see Medicaid or Medicare cuts having on primary care?
Suggested reading: The American College of Physicians (data rich) or try
Healthaffairs.org(more explanatory)
Bottom line: How do the policies or positions you stand behind support primary health care?

2. Who should have health coverage? Most well-intentioned people want to be fiscally responsible but also do not want to see others suffer. So how do we be good stewards of our medical resources? What plan will do the most good in the most cost effective way? If you are convinced that certain groups can not be covered, then consider what the plan should be for them, for as we all know, everyone gets sick, insured or not.
Suggested Reading: ProCon
Bottom line: Are your views on health coverage authentically aligned with both your personal ethics and your fiscal sense of responsibility?

3. Follow the money. In what ways do traditional free market practices and fee-for-service payments influence the cost and quality of our healthcare? Health care industries -- even nonprofits -- have been enjoying historic financial growth and expansion, even through the current recession, and exert powerful influence on Capitol Hill. Do we understand the ways that influence shapes our healthcare? Do we trust the free hand of the market to take its natural course in healthcare, or are we worried about corporate misbehavior? What about the argument that a fee for service business model promotes productivity (rapid patient turnover, tests, procedures) over quality or long-term outcome? What advantages might a single payer model, like the military's, offer? What about ideas like "accountable care organizations," "medical homes", or "bundled" payments that are designed to reward improved outcomes?
Suggested audio: NPR "How to Win Doctors and Influence Prescriptions"
Suggested reading: iwatch, kevinmd
Bottom line: Will the payment model that you favor the most put the patient's best interest front and center?

These are not easy questions, but they are approachable. Consider pulling out one of these, or others like them, the next time you are in conversation with someone whose opinion you value. Why not invite a panel of local doctors and nurses, and perhaps some local small business owners, to field such questions at your local community center? Or, if you like to do your own digging, go to a professional organization's site, like the AMA, AARP or ANA to get a feel for their positions. The key is to find sources that you trust, and tune out anyone who is speaking at a volume louder than conversational. And do keep in mind that channel surfing over cable networks is not research; it's more like yodeling in a canyon.

That's my advice, and my guess is that its probably not very different than what your own doctor would prescribe.