Health Care

This is a massive, volatile and emotional subject. I have avoided this subject for a while, knowing what a huge undertaking it is. I will try to generalize today, and then break down the subject further in later posts, i.e.--our personal responsibility for health care costs, insurance companies, tort reform, etc.

We have the best health care in the world. Is it perfect? Not even close. But, if you have ever had to have medical care in another country, you know that even with all its flaws and blemishes, our system is still the best in the world. Why? There are many reasons and I don't pretend to know all of them, but some of them are as follows: 1)Americans are compassionate and kind people, 2)the vast majority of health care workers really care about people and want to help them, 3)American ingenuity and innovation constantly work to improve the way we do things, 4) the ability of private industry to streamline and work faster than larger bureaucracies.

Health care in America has some flaws: the expense, the wait, medical mistakes, and thoughtless health care providers and workers. Some of these are fixable and some are largely out of our control, but we as individuals can help with all of them. I would like to address each of these in reverse order.

Thoughtless health care providers and workers:

Like it or not, health care is just a work place for some people. Almost all of the health care professionals I've met in my life are good people and good at their jobs. But, as with any profession, there are unkind people who hate their jobs or are downright incompetent. We all have personal horror stories or have heard some, but I believe that those are still the exception, not the rule. The best thing that can be done about these situations is to deal with the situation directly. When we have specific problems, we need to take the initiative to address the specific issue rather than declaring the system broken. If an x-ray tech is rude and unkind, his supervisor should be contacted.  There is absolutely nothing the government can do to fix this problem--we as consumers need to take care of it ourselves.

Medical mistakes:

Surprisingly enough, health care workers are human. They make mistakes just like everybody else. The difference is obvious though between a medical mistake and a grocery store employee's mistake. When people's lives are at stake, we expect, even demand perfection. This expectation is not only unrealistic, it is harmful. I don't know a single health care professional that would intentionally do anything to harm someone in their care, but mistakes do happen. There is also a huge difference between an honest mistake made by a human being and gross negligence due to incompetence or some other obvious factor. Gross negligence should be punished by reimbursing medical costs and firing or canceling of medical licensing. In some cases, medical licensing boards are too hesitant to do so. But in the case of mistakes, punishing people for being human is overkill.  Payment should be made to cover the cost of any corrective procedures, but dragging people into court for "malpractice" is counter-productive. Unless there is a repeated pattern of negligence and incompetence, I don't feel it rises to the level of malpractice.

Very often, mistakes are made when medical personnel are working too many hours, have too many patients to see, have insufficient training or have insufficient information from their patients. It is imperative that we as patients become active participants in our health care. We have a responsibility to research our ailments and be prepared to have an intelligent discussion with medical professionals. If we are uncomfortable or confused about something, we must get further information. We have the right to change doctors or make sure that they are Board Certified--not all doctors are. And we must provide full disclosure to any doctor we meet with. Withholding information is not only dangerous, it can be deadly.

There's a lot more to this issue that I will address in a future post.

The wait:

It is incredibly frustrating for all of us to have a long wait before we can see a doctor. Multiple factors contribute to this problem. It starts with the fact that there are fewer and fewer general practitioners around. They have been driven out of business by puny reimbursements and exorbitant malpractice premiums. Fewer doctors=long wait times. In conjunction with this, more people feel they need to see a specialist. It's also a lot easier to request a visit with a specialist when we know our insurance will pay for it. More visits to specialists=more wait time. People that are not insured, will often use the ER for any medical need. ER's crowded with colds and headaches create long waits for real emergencies. Non-emergent cases in ER's=longer wait times. Malpractice premiums have become so onerous in some states that doctors simply cannot afford to practice medicine anymore. PA is one of the worst states in the country for malpractice premiums. As a result, doctors either leave the state, drop underinsured patients or narrow their practice. Many, many OB/gyn docs have stopped delivering babies because they can't afford the insurance. Even if they've never had a problem with a delivery, they pay the same malpractice premiums as those who have had problems with malpractice. Fewer doctors=long wait times. And lastly, many specialties are no longer appealing to upcoming doctors because the pay is horrible, the hours are long and the malpractice insurance is too high. This is particularly true of the two specialties already mentioned, OB and GP's, but is also true for pediatricians. Fewer doctors=long wait times. It's only going to get worse, unless we make some changes.

The biggest help in this arena would be national tort reform. It's the one thing the government could do to be useful. Frivolous lawsuits that waste oodles of money and time have driven the cost of malpractice insurance to the point of ridiculousness. Again, I'll use PA as an example. They have one of the biggest lawsuit-happy populations in the U.S. As a result, the exorbitant malpractice premiums have driven up the cost of health care for everyone in PA, both to cover the increased premiums and due to doctor shortages. The state has had to subsidize those premiums with tax dollars in recent years to keep every doctor from leaving the state. If tort reform were passed, those who bring frivolous lawsuits would be required to pay the court costs of both parties. This would severely punish gold-digging patients and ambulance chasers and greatly diminish the number of frivolous lawsuits. It would then be up to the insurance industry (who I'm sure is not making a dime off of malpractice insurance...not) to lower the premiums to a more reasonable range. They have done it in Texas and it works.

The expense:

We all hate to go to the doctor. But we sure love him/her when we get fixed. Then the bill comes and we start cussing those horrible doctors and all the money they're making at our expense. Americans are in serious need of some perspective here. In the first place, doctors spend a minimum of 11 years in school/training after high school. The average amount of student loans incurred by most doctors for their training is $250,000. Before they ever start practicing medicine, they are deeply in debt. They are not allowed to work during medical school and unless they are independently wealthy, live on student loans for the four years of medical school. They are then paid a pittance for the years that they are in residency, typically making less than minimum wage for the number of hours they work. Then as they enter their profession at age 30-35 (sometimes older depending on the demands of their specialty training), they finally get to start paying back their student loans and start saving for retirement. The 10-year head start that most people have on retirement savings is lost for doctors while they get their training. Now, I don't know any doctor who is asking for sympathy or pity. They willingly make the sacrifices necessary to become a doctor. But we need to cut them some slack. If you want to make a doctors wages, then you too, can go to school for 11+ years, and will be paid the same.

It's easy to blame the doctor for the high costs of health care, because he/she is the "face" we associate with our health care. But consider this: medical supplies, medicine, medical equipment, office overhead, nurses and office employees all cost the doctor money. Every bill you receive form the doctor reflects those costs. (They might be wise to itemize those costs for their patients, so they could see the breakdown.) The aforementioned list is also a list of rising costs, which we as patients never really know about. At the same time, doctors wages have not increased in 20 some-odd years. As the costs have increased, doctors have taken less pay. But they cannot pay back their loans, save for retirement, provide for a family and pay for all the other costs themselves. Like any business, the operating costs are passed on to the consumer. Furthermore, the people that do not pay their bills, people that are treated for free at the ER and who use Medicare/Medicaid (which reimburses the doctor at about 30%, if he's lucky) drive up the cost of health care for all of us. Every single one of us who pays is paying for those who don't or can't. 

Sadly, in many ways Americans are spoiled. We want, nay demand, the best health care in the world. We insist on perfection in health care professionals and we want it all for free. It does not, cannot and will not work that way. There is so much more that we can do and need to do but this post is too long already. I'll address more of this soon. But an important point to make right now, is that government is not the answer. Politicians that are pushing for nationalized health care are selling the most poisonous of snake oils. If you think that a government that is now over $3 trillion in debt can lower the cost of anything, then I have a Bridge to Nowhere to sell you. I will address this in greater detail, but the government has created or contributed to a lot of the problems we are now facing in health care.  If you think the system is bad now, it will be abysmal if the government takes over. We can all help by thinking about what we can do as individuals to improve medical treatment and lower the costs. As with anything, perspective coupled with personal responsibility is always a great place to start