Sorting Fact From Fiction on Health Care (Significant change in patient/doc relationship)

In recent town-hall meetings, President Barack Obama has called for a national debate on health-care reform based on facts. It is fact that more than 40 million Americans lack coverage and spiraling costs are a burden on individuals, families and our economy. There is broad consensus that these problems must be addressed. But the public is skeptical that their current clinical care is substandard and that no government bureaucrat will come between them and their doctor. Americans have good reason for their doubts—key assertions about gaps in care are flawed and reform proposals to oversee care could sharply shift decisions away from patients and their physicians.

• Americans only receive 55% of recommended care. This would be a frightening statistic, if it were true. It is not. Yet it was presented as fact to the Senate Health and Finance Committees, which are writing reform bills, in March 2009 by the Agency for Healthcare Research and Quality (the federal body that sets priorities to improve the nation's health care).

The statistic comes from a flawed study published in 2003 by the Rand Corporation. That study was suppose to be based on telephone interviews with 13,000 Americans in 12 metropolitan areas followed up by a review of each person's medical records and then matched against 439 indicators of quality health practices. But two-thirds of the people contacted declined to participate, making the study biased, by Rand's own admission. To make matters worse, Rand had incomplete medical records on many of those who participated and could not accurately document the care that these patients received.

It is fact that more than 40 million Americans lack coverage and spiraling costs are a burden on individuals, families and our economy. There is broad consensus that these problems must be addressed...They should be - giving more people access to healthcare is a worthy goal - reducing the cost of healthcare is a worthy goal - preventing the dropping of people who lose their jobs from insurance coverage is a worhty goal - providing coverage for people with pre-existing conditions is a worthy goal - providing "universal" coverage paid for and therefore controlled by the government might be a step toward meeting those goals but it is not a goal in itself - but Obama has made it as important as those worthy goals, because it's what he's really all about - providing healthcare is only a stop on the way to his worthy goal: gaining as much power and control as possible over people's lives......

“It is fact that more than 40 million Americans lack coverage and spiraling costs are a burden on individuals, families and our economy. There is broad consensus that these problems must be addressed...”

Statements like this are dogmatic in nature and are part of the problem. When one breaks down this 40 million figure it becomes apparent that a large number of these are the young who have decided to forego insurance. Another chunk are people who are eligible for existing programs, but haven't signed up (I have personally seen this with patients, which is why hospital social workers are often successful in finding funding for patients who need the help).

Further, those who don't have insurance still get care, and the medical system generally winds up eating those costs. In border states this most definitely includes patients from Mexico who can't get the care they need there, and thus go to US emergency rooms where they are admitted and treated (I've taken care of several of these patients myself).

Taking care of these patients is the right thing to do, however, we ought to be able to go to the Mexican government and demand payment for their care, given that it is the lack of care available in Mexico that prompts their citizens to use US facilities. Incidentally, how many American businesses give things away free to non-citizens? Health care professionals and hospitals do all the time, yet the ‘greed’ label that we get labeled with.

Dismantling the current system in order to fix the current problems will only bring on many, many more problems that do not now exist. I agree entirely with your points about dropped coverage and pre-existing conditions etc., and with your assessment of Obama’s motivation. I just heard that a friend's wife was diagnosed with glioblastoma multiforme (same kind of brain tumor Ted Kennedy and Robert Novak had). It's essentially a death sentence and they have four young children.

We all hope that in the future there will be cures, or at least effective treatments for these types of tumors, and any other condition that can shorten peoples lives. The development of those kinds of treatments may have a basis in part on research that occurs in basic science laboratories at universities etc., however, the development of effective treatments based on the science is dependent on capital investment of the type that our free-market system supports. Take away financial incentive from pharma, biotech, and device manufacturers and innovation will slow, if not stall. That's not the way to provide hope to future generations.

I doubt there is a single member of the Senate or House, or the entire executive branch of government that knows as much about health care as those of us who provide it do, yet as physicians we are on the fringe of the debate on how best to fix what is wrong and improve the system. That is because, as you pointed out, it isn't about doing what's best. It's about ideology, power, and MOST importantly for the the vast majority in public office, stature. Politicians as a whole are attracted to elected office not as much as by power and money as by stature.

Politics attracts egotistical people, and they can't stand having to share stature with anyone. That is why they seek to control all that they can control. It puts a label on those they control as ‘less’ than them. This is a very often overlooked dynamic that is at the root of much of what happens in government at every level. That is why we need term limits, and that is why we need to stop treating politicians like celebrities. When you provide a stage, you attract those who want their names in lights. Let's make politics about public service, and politicians limited time public servants, the way our founders intended.

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