One year after passage of the Patient Protection and Affordable Care Act, the debate roars on, in Congress and everywhere else. And these debates often revolve around a big question, even when it is left unspoken or implied: Is health care a basic human right?
In 1990 I made a quantum leap from practicing in the Navy's single-payer, universal-coverage health care system into civilian pediatrics. Having been insulated from the profit end of health care for almost a decade, the move to the U.S. healthcare system of haves and have-nots turned out to be a culture shock.
My first civilian job was at Wood River Community Health Center in Rhode Island, and one of my first patients was Jennie, a 3 month-old who had been placed in foster care because of her mother's drug addiction. Being in foster care meant being on Medicaid. Poor children on Medicaid have several strikes against them. Not only will a provider often lose money by seeing them, but these children are on Medicaid because they are special needs patients, or in foster care because of abuse and neglect, or from impoverished circumstances that have put them at risk of malnourishment, or exposure to lead or smoke. These are the most labor-intensive patients in a pediatric practice. How well they are cared for is the measure not only of a pediatrician, but also of a society.
By the foster mother's description, Jennie had a generalized seizure -- a convulsion -- at home. Her physical exam was completely normal. I called the only pediatric neurologist in the state at that time and faster than I could say "foster care" he understood the kind of reimbursement he could expect. He insisted he did not need to see the child or do any tests. I was shocked. No EEG? No imaging studies? This was the same doctor who routinely performed unnecessary but very expensive EEG's on every insured headache patient he saw.
"What's the point?" he challenged. "The mother is a drug addict; this was a withdrawal seizure. You don't need to rule anything else out. Load her up on phenobarbital."
Phenobarbital is a sedating drug that back then was commonly used to treat seizures in children, but we usually looked harder to document and find a cause for the seizure before we settled into therapy -- especially in a 3 month-old.
I was angry and backed into a corner. I told Dr. Do-Little that if he would not see her then I would refer her to the ER at the Rhode Island Hospital, and let them contact him. He was on the staff there and would have no choice but to respond. Do-Little begrudgingly relented but got his way in the end. He was rude to the foster mother, and did only the most cursory exam on the child. He started medication without doing any tests.
Practicing pediatrics in the Navy meant I always had the resources to deliver state-of-the-art care -- and no excuses not to. But here, no matter how strongly I felt that my patient should receive a certain service, I might not be able to get it for her because of her inability to pay. It was the first time in my medical career that I knew what a patient needed, and had to settle for something less.
Did Jennie deserve better? Did she have the right to the same health care as, say, my daughter? These are awfully solemn questions for public discourse, and are likely to keep us running in circles through a haze of abstractions and ideology. We need to think less like judge and jury over who deserves health care, and more like stewards.
As a nation, even in this recession, we can claim remarkable prosperity relative to the rest of the world. (Nowhere is this truer, incidentally, than in the highly profitable private health care industries.) More inspiring, however, are the brilliant medical advances that continue to emerge from our academic centers and teaching hospitals. This drive for new knowledge and innovation in the pursuit of health and healing is our real treasure -- America at its finest. It has always been the best in people, not greed or profit, that has driven meaningful medical progress.
Yet the system isn't working for us. We are spending too much, and getting too little. We need to be better stewards of our medical riches. We need to see ourselves as stewards, and ask questions from that perspective, rather than who deserves what slice of the pie.
So let's redirect: Given our considerable medical resources, what moral responsibility do we all share in the fair, prudent, and just allocation of these resources. From this position of stewardship, we are likely to ask more practical questions: What would a smart, compassionate, affordable health care system, released from the stranglehold of special interest, look like? What preventative and therapeutic services should it deliver? What responsibility does the individual hold? Once we have a clearer picture of what we expect of ourselves and the system, we can turn to how we can make it affordable.
Stewardship gives us direction and purpose. If we can tune out the noisy rabble-rousers, reframe our questions, and commit to responsible conversation that is grounded in our own common sense and decency, I believe we would find much common ground, and make a lot more progress towards a just and cost-effective health care system.
Follow Maggie Kozel, M.D. on Twitter: www.twitter.com/barkingmd
No one could have done it better.
A substance had been placed in use to reduce the risk of premature births. A drug company took out a patent on the substance Doctors prescribed and Pharmacists have been selling for $40 a bottle.
Their charge of $1,500 per dose was "Justified to cover Research and Development".
Our courts would probably allow a large company to patent the shovel or wheelbarrow.
As the scorpion said with tears in his eyes, "I didn't mean to sting you; it's just in my nature.".
How to Solve The Health Care Fiasco in The U.S
http://www.ehow.com/how_5122993_solve-health-care-fiasco.html
Granted, we'd have to do some changes beyond just switching to a socialized system to have a more efficient universal system. More general practitioners and fewer specialists for instance (that can be had with some retraining of the existing population), and generally returning the focus to primary care. Reducing how many high-end imaging systems we purchase (MRIs actually have YET to be scientifically shown to be superior to cheaper imaging technologies in diagnosing diseases, yet we buy them all over the country...it's bizarre enough we're mocked for it -- other countries have fewer and still are just as good at diagnosing and treating disease).
All that would produce a far, far cheaper system than what we have now, but one that is just as effective at diagnosing and treating disease.
Universal Health Care would at worst give you coverage and cost you nothing, and at best save your money (or result in getting paid more at work).
Thank you for your article and your compassion towards the "medical have-nots."
I'm reminded of the axiom, "Follow the money." Making money in the medical industrial complex is as easy as prescribing products and services that have a profit margin for the entire supply chain. Therefore, the prescribers, at the point of sale, need to differentiate between unhealthy payers and unhealthy non-payers.
Unfortunately, the unhealthy consumer, is not often the direct payer. If they are the direct payer, they don't have information on costs and effectiveness, so they can't make informed choices. The medical industrial supply chain is complicated and opaque. The decision on how much to spend is not in the hands of the person who directly benefits from the spend. It is typically in the hands of the prescriber, who often has no incentive to control costs.
So who is being compensated for health?
Our family pays the first $5k on any medical expense, we shop around and deal directly with health professionals. For maintaining health, our family focuses our resources on nutrition and fitness to strengthen the body and the immune system.
A dialogue on reform needs to focus on the consumer, enabling their informed decision on the expenditure of resources that they ultimately control. This will simplify the system, allowing us to identify where the money is going.
There is enough money. With simplification will come clarity. Then we'll find that there are resources and compassion for those in need.
They seem to "know" something about gynecology as well. Most women (60%) have a CS for their one child - but only after they have had 3-5, less-than gentle, surgical terminations of pregnancy. their gynecology - lower uterine adenomyosis, posterior wall fibroids and endometriosis at the uterosacral insertions, dominate their gynecology. In the West, more random gynecology arises from womens' first labors that are "medicalised" or "naturalised". Both result in significant gynecology.
All of this is preventable with a little, collective and moral, endeavour.
As a family physician and foster mom, I couldn't agree more!
What if we. . . .
reframe the question from "Who's gonna pay for this?" to "What do we want?"
Communities nationwide are not waiting for politician-savors. They're creating
their own ideal clinics and hospitals.
http://www.idealmedicalcare.org/blog/patients-reinventing-hospitals/
Ideal clinics:
http://www.idealmedicalcare.org/ideal-clinic.php
Ideal hospitals:
http://www.idealmedicalcare.org/ideal-hospital.php
It's time to do the right thing for patients. The time is ripe
for innovative new models.
A populist movement is brewing in health care!
Pamela Wible MD
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“It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.” - Florence Nightingale
Pamela Wible MD
The problem IS the current health care system. It can't be fixed; the involvement of for-profit insurance companies in providing coverage alone guarantees that fact, although there are plenty of other unworkable components. The solution is to scrap the current system altogether and bring every citizen, regardless of age, employment status or income, in under the same single-payer plan (NOT administered by a for-profit corporation).
There's plenty of room for debate in the details, but we can't even start that conversation until we stop pretending that the old system can be (or is even worth) saving.
As for your problem with "anecdotes." I've noticed that people use that word when they want to play down the fact that what is being relayed are people's experiences. You know, the things that actually happened to people. Far from not being useful in solving problems, they provide one of the best possible sources when policies are being debated, as those policies SHOULD BE all about creating a system that improves people's experiences. Really, if that's not the goal, what is?