The alleged reformation of our "broken" health care system has received unparalleled political attention over the last few years. This issue has generated debate between politicians and other politicians in Washington DC, along with conversation between people from "Wall Street to Main Street" (to borrow from one of the campaign slogans of our chief of the executive branch). When the President signed the health care "overhaul" bill into law in late May 2010, confusion and uncertainty were the predominant feelings among US citizens, relating to the unclear, behind-closed-doors approach legislators took in creating this thousands-of-pages of perceived red tape. Much of the country is polarized about the issue. However, this heap of legislation has not been defined; its true essence remains rather ineffable.
The key elements to creating meaningful change to the U.S. health care system -- physicians and nurses -- were overlooked. Instead, out of touch, deal-making politicians (over 95 percent of whom are lawyers by training and unaware of the health care system's modus operandi) acted as the impetus for change. Our president alluded to physician support of his health care bill, claiming it was backed by the American Medical Association (AMA); the truth is that less than one-theird of physicians are members of the AMA and even this non-representative organization was outraged at the President's lack of willingness to consider tort reform, (his July 2009 speech at AMA headquarters in Chicago received a flock of boos). United States citizens have been continuously deceived by a leader very skilled in the practice of rhetoric (rivaling the rhetorical dexterity of any leader in modern history).
One thing needs to be cleared up before we go further: the United States has the best quality of health care in the world. However, this quality of care exists in a problematic system. The politicized numbers that have depicted U.S. health care as mediocre are tools of propaganda used to promote a political agenda. In reality, physicians come from all over the world to participate in residency programs in the United States in order to learn how all fields of medicine are practiced. The standards of medical care and expectations of quality are second to no other country in the world.
The World Health Organization (WHO) ranking system skews this picture, which is why the United States received a lower-than-is-reality ranking. For example, the WHO uses infant mortality as a key ranking figure. Very few countries in the world attempt the number and degree of high risk births as the United States. When our obstetricians are attempting 22 week deliveries of fetuses (38-42 weeks is normal gestation), there will certainly be a degree of morbidity and mortality associated with this practice, accounting for the low rankings in this weighted field.
Additionally, very few other countries in the world assume the care of anyone brought into the hospital (emergency departments in the United States are at this interface), including indigent patients of all varieties (homeless, jobless, criminals, drug addicts, and non U.S. citizens). Lack of ability to pay does not matter in the United States emergency room (which will be addressed later). This practice of treating all patients hurt the U.S. in WHO cost-efficiency ratings. Nonetheless, physicians in the United States are pioneers, innovators, and the force that drives the greatest health care engine in the world.
Experience in the trenches on the front lines of medical practice, together with communication between various levels of health care workers, has revealed four key areas that must be elucidated to provide for continued amelioration of the U.S. health care system. Attention to these areas could also create a great deal of cost-cutting. The crippling effect the medical-legal system has on health care in the United Sates is the number one issue.
Next, the U.S. population is the unhealthiest population in the world, which manifests as exorbitant health care cost through a protean number of related diseases. Thirdly, the ever expansive social welfare state further puts Federal accounts and balances into the far negative. Lastly (and probably least important in terms of health care cost), the solution to provide increasing insurance coverage through Federal means will be debunked by the above oversights and as a result, compromise health care.