You and I Live in the 21st Century -- Health Care Is Back in the 19th

Everyone complains about health care, but the real problem is healthcare. As two words, health care is a service offered by trained professionals to people known as patients. As one word, healthcare means the system in which the professionals work and where patients receive care.

The healthcare system is broken. It doesn't work because healthcare still thinks it is in the 19^th century, but we live in the 21^st.

In the 19^th century, there was a direct relationship between the doctor and the patient. The doctor delivered both the baby and the bill. The patient received the new child and paid the doctor for his services.

Today, health care is provided by a team. When I asked my mother-in-law who her doctor was, she responded, "Northwestern University Hospital." She could not identify an individual human being with a name.

Patients do not pay their bills today. Insurance policies -- via private companies or government agencies -- pay our medical bills. The lack of a direct fiduciary relationship between doctor and patient prevents the free market from functioning.

Micro-economic disconnection, as described in Uproot U.S. Healthcare, shows how separating or "disconnecting" supply and demand -- the free-market forces -- produces an ever-rising, unsupportable cost spiral. Because the patient doesn't pay the bill, he or she has no reason to economize. Because the doctor wants "everything done" and knows that an insurance company (not the patient) is paying the bill, the doctor has no incentive to economize. The insurance company certainly does economize. But under our current system, when an insurance company "economizes," it denies or delays our medical care.

The phrase "moral hazard" describes how freely we spend money when it is not our own. We have no hesitation going to the emergency room -- spending $500 -- for our child with a fever instead of going to the pediatrician and spending $40. It makes no difference to our wallets, so why should we economize?

Harmful consequences of this disconnection -- consumer disconnected from payer -- extend well beyond money. Many people use the word "fiduciary" to refer solely to financial relationships. However, a fiduciary is someone who temporarily accepts power or authority from one person to use for the benefit of that person. A patient gives power to the doctor -- in the role of fiduciary -- to cut the patient open and operate. If any other person did what the surgeon does, it would be classified as attempted murder.

In today's disconnected (patient-to-doctor) world of medical teams, third-party payers, and malpractice lawyers, the fiduciary relationship is gone, and with it went our faith in doctors. Though today's doctors can do so much more for us than doctors could in the 19^th century, we no longer trust them. They have fallen from God. They have passed through fiduciary and are now approaching "perp" (perpetrator) status.

Nineteenth-century scientists developed laws or rules in physics, chemistry, and mechanics. They could precisely predict events like where a planet would be or how much bicarbonate we get each time when we add H₂O to CO₂. As medical capabilities dramatically improved over the years, patients continued to expect the same degree of predictability in medicine as in physics or math. We thought doctors could guarantee a specific outcome to a specific patient.

In the 20^th century, Werner Heisenberg enunciated the uncertainty principle and showed that we couldn't predict or guarantee anything at all. Nevertheless, healthcare stayed with Newton's mechanical predictable world. Today, instead of accepting a bad medical outcome as misfortune, unavoidable human error, or limitations of medical knowledge, healthcare blames the doctor, cementing her or his 21^st-century status as a perp.

In the 19^th century, the highest measure of success was efficiency. The quicker and cheaper you did something, the better. The person who makes the most widgets in an eight-hour shift is the best. So today, if the best doctor is the most efficient, then the best doctor sees the most patients per day and therefore spends the least time with each patient. But wait! That is not right. That is not what patients want, nor is it the way to practice quality medicine.

Right now, my hospital expects me to be efficient. This translates to my seeing 4.2 patients per hour, which allows fourteen minutes per patient, seven of which are consumed with paperwork. This is 19^th-century thinking that produces perverse incentives: the system rewarding the very behaviors we don't want.

If you want a healthcare system that works, drag it from the 19^th century into the 21^st.

J.D. Waldman, M.D., MBA is a tenured professor, practicing physician, systems thinker, adjunct scholar for the Rio Grande Foundation, and the author of Uproot U.S. Healthcare.

Where is it broken ... we’ll let me share here.

I had a routine physical exam Dec 8th. Age 50-60 male, live in Florida. Blood work was ordered and blood was given Dec 27th.
I wanted to wait to call the doctors office until after the holiday’s so as to be nice. So I called yesterday, Jan 4th and ask for a copy of the blood work results. Fine so far right?

Doctor’s office is open and almost fully staffed yesterday. I called and the top Doctor is on vacation til next week. Everyone in the office is under orders that noone can get their records or blood results until he returns. Went through 3 females up to the office manager and got the same ole directive in my face. Now I paid for these tests because I paid for my insurance.

I now call the lab where they took the blood. Female says we don’t have results here, so I get phone number for Tampa office where the blood tubes were sent. Female there told me Florida is not a RIGHT TO KNOW state so they won’t provide me with my own results unless my doctor authorizes it. (He’s away for 6 more days) So suddenly lack of a ‘right to know’ statue allows this company to implement a ‘right to deny’ policy.

Tell me the system isn’t broken. There was a day when the patient was the customer but now, the doctors, labs and insurance companies consider the patient as a commodity and toy with us as if we are outside our own health care.

>>>Where is it broken? This is one of the worst comments I continue to hear - yet no one says where it is broken.<<<

I agree.

Just speaking anecdotally -

When I had my skin cancer, it took seven weeks from diagnosis to removal.

When I had what appeared to be a heart attack, I was seen immediately, followed by specialist after specialist, who saw me immediately, followed by a cure, which took a few weeks.

When I had gout, I was seen immediately, given medication on the spot.

When I caught brucellosis - on the tundra in western Alaska, by the way - I saw a doctor in Bethel immediately, was given a jet to fly me to Anchorage, where a doctor saw me within four hours.

When my wife was miscarrying our child, she was immediately driven 60 miles to the hospital, then given a room and doctor before checking for any indication whether or not she could pay or had insurance. We had neither. The hospital gave us care anyway, and a beautiful little boy, and decided not to bill us $280,000. If I ever win the lotto, that’s the first place the money is going.

I have relatives in England, Italy, and South Africa, and they all tell me that their health care is much, much worse. And yet we’re moving towards their systems. God help us.

I dont see where it is broken, you seem to have a delay in getting blood results returned. Over the Christmas holidays... the problems you noted are delays due to government regulation and lawsuits - the liability of a doctor not telling you.

Are they not allowed a vacation like you are? The fact you over the holidays decided to get work done does not show where or how an entire system is broken.

My wife had knee surgery the day before Thanksgiving, we arrived at 0900 - I picked her up at 1100, she was on complete bed rest until after Christmas now in months of PT. I have had to work and run the family now for almost two months, do Santa, school, vacation, shopping, taking my wife to doctors where she is well treated and professionally handled and you don’t see me bitchen.

You sound more like a whiner then a mature 50-60 year old.

How about knowing if there was an immediate problem, chances are the doctor would call you. I am guessing your blood test will come back so you will only complain someone else is not paying for your statin drugs.

A system where government programs distort prices by limiting compensation to doctors to the point that patients are receiving bills for $200 aspirin is broken.

A system where nobody will tell you how much the $200 aspirin is until AFTER you’ve already received care and been billed is broken.

A system where illegal aliens are pouring over the borders and getting their $200 aspirin for free is broken.

A system where a normal patient can’t afford simple medical procedures without pre-paying for care through an ‘insurance’ company is broken.

A system where that ‘insurance’ is somehow dependent upon the patient being tied down to a specific place of employment is not only broken, but just plain stupid.

It could all be fixed tomorrow if we were to get the government out of the business of expanding its own power and into the business of working in the interest of the American people. If only...

Modern Medicine has meant a lot to Maine.

People who used to die in February now linger on at great cost, inconvenience, and pain until May. But there is a bright side. At least in May the dead can be buried, instead of being stacked in a shed at the cemetery like frozen cordwood.

BTW, what is with this "bloodwork" fetish? I sure hope you are not taking any of these statin drugs to lower "high" cholesterol. Drop 25 pounds and take COQ10, Cod Liver Oil, pycnogenol,and grape seed extract, as heavy as you can stand. Take it in powder form mixed with water. Vitamin pills offer little or no rapid absorption, and most times none at all. Take a drink every evening. 2 OZ good whiskey. If you feel better, take another.
Remember what Dr. Holmes said,"If the entire pharmacopeia were to be thrown into the sea it would be a benefit to mankind and harmful for the fishes." He also said (or some old geezer did), "that we eat 1/3 out of necessity, 1/3 for pleasure, and 1/3 to support our physician." So eat 1/2 of what you eat now, fellow geezers, and quitchabellyachin'! My bill is in the mail.

BTW, if your appearance in short pants will not frighten women and children, get some exercise. Bike path?

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