Health Care

Fixing our broken health care: Part II

February 28, 2014
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Editor's note: This is the second part of a two-part post. The first part is here.

Personally, I might not have approached financial access the way our Congress did — at least through Obamacare — but I am singularly unimpressed by blindly belligerent attitudes and alternative-less Republicans.

There is no real discussion in Washington, and our state capitol isn’t far behind when it comes to blind ignorance. We need a clear agenda, regardless of party affiliation.

With much work needing to be done, I offer some solutions to improve the key challenges of cost, quality and access — which I discuss here — below.

Cost

Costs continue to be a major issue. No one has the strength to do anything about it at this time.

Lobby forces are very well paid to maintain the incomes of those profiting from health care by assuring no real action. Insurers are on tenterhooks for fear providers will not honor their cards. 

At some time, someone will have to say that some procedures are only worth so much and put limits on charges. Individuals cannot do this, as they don't have the knowledge or organization to impact the system.

Do you think the mental marvels we elect to go to our state capitols or Washington can come up with sane and effective policies? They seem more interested in discrediting each other than actually solving real problems.

Quality

A major check on quality has been our malpractice system. Yet this lottery is loaded with cost-increasing forces. Doctors want to protect themselves with unnecessary tests (that they also charge for). Lawyers want to be sure you know that you can sue. Defensive medicine slowly turns to standard care. And, yet, the very reasons for malpractice suits are not being eliminated. We need to stop poor practice and stop unnecessary lawsuits.

Quality needs to be defined by the practitioners in a way that they can determine good from bad and then root out the bad practices. They must be willing to speak about each other. We need to use measurement tools and ratings to make choices.

Referrals should go to the better-qualified specialists, not simply those on the same hospital’s staff or those who bought drinks at the last medical society dinner.

Health system administrators must become more concerned about the patients’ well-being than they are about their own system’s bottom line, and they must resist the temptation to interfere with the best judgments of their employee doctors.

How about a little truth in advertising? Many providers talk about the things they do well, but usually not about those areas where they need improvement. Simply saying “we’re number 1” is usually dishonest and not helpful.

We need to support our training programs and universities to be sure that we have a dependable supply of well-qualified personnel at all levels. With more people seeking care, we need more people to provide care. This is not a time to skimp on aid to our educators.

One of the largest areas of unfinished business is the matter of reimbursement. We get what we pay for, and right now, we pay for specific procedures. We don’t pay physicians to spend time with patients, and therefore they usually don’t. We do pay them to perform procedures, and they do a lot of them. We need to pay doctors to be caregivers, not procedural technicians. We need to pay well enough to have doctors and their teams perform primary care. Just think — how often do we need specialized, esoteric procedures? Most of us will never need highly specialized care. We need routine primary care.

Access

Access in a greater sense means being able to be seen by the right caregiver at the right time.

This assumes that there are enough caregivers to meet the population’s needs, an assumption that will be tested very soon when our Medicaid ranks expand significantly and many younger people have insurance cards.

There is a growing understanding that we need to re-organize health care providers if we are going to meet the people’s needs. Doctors’ offices are going to have to become mini-clinics in order to serve more people. Organized clinics must be able to attract caregivers to meet significantly greater demand. Hospitals are going to have to set up lower cost primary care services, and we should not accept their cries that people are misusing the emergency department by coming for primary care, since the hospitals are the ones who can organize lower cost primary care clinics next to their expensive emergency rooms if they want to. No one is forcing providers to charge more than necessary, and no one is forcing them to function in a way that continues to assure that some will be seen and some will not. If some perceive regulations to be in the way, perhaps the regulations need to be changed.

Perhaps we need to start over, although it is very late. The train literally has left the station.

We need to put our options for costs, quality and access on the table and then look at them by priority. For each priority, we need to clearly define what we want to accomplish. Then we need to develop an action plan to drive the change we need. Then we start over again and with the next priority. This is a classic planning model — something that has been sorely lacking in the debates over health care policy.

We need positive action, not resistance to change.

Remember, soon there may be no room at the health care inn for you. We need some intelligent and rational solutions to real problems — not finger pointing. The unfinished work is piling up.

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