Archive for the ‘Healthcare Reform’ Category

What We Need Now Is True Medical Care Reform

Sunday, November 8th, 2009

The current health care reform legislation is, more precisely, health coverage reform. The intention is to cover more people through changes in the health insurance system. It will do little to control costs. In fact, the cost of the legislation will be much higher than touted.

The problem that has not been touched in the current legislation relates to how we provide medical services. The main driver of increases in medical costs is our technology-based medical service system. This causes an economic squeeze in health care that has already required rationing of medical services. Even with health insurance reform, the cost of medical care will continue to rise, and the need for rationing will increase. (more…)

Personal Care vs. Individual Care vs. Herd Care

Tuesday, October 20th, 2009

The science of medicine can identify genetic, biochemical, physiological, and anatomic characteristics and measure how they are modified by disease in each individual. For example, the combination of hypertension, diabetes, and liver disease may be unique in one person and require treatment quite different from others with the same disease manifestation. Addressing these differences is the basis of individual medical care.

Many important differences that affect disease manifestations and responses to treatment, however, are difficult to quantify. Every person has his or her personal theory regarding the maintenance of good health and the nature of illness. These result from the combination of cultural background, education, vocation, standard of living, experience, and world view. As you can imagine, they are difficult to quantify.

These personal attitudes enhance or impair the responses to drugs and other treatments. A good example would be (more…)

The Assault on Medical Professionalism

Saturday, October 10th, 2009

Medical care is not a trade.  The professional commitment required is more than simply a calling to a discipline. It involves ethical conduct that recognizes the contract between the patient and the physician. The welfare of the patient always takes precedence over the doctor’s self interest.

Most people have turned their medical care purse over to third parties, who now negotiate with the doctor over care.  These insurers and managed care entities pressure the doctor to act as “gate keeper” and ration the patient’s care in ways that may not be in the patient’s best interest.  Doctors have a conflict of interest and are placed in an unethical position.

Doctors still interested in doing things in the best interest of their patients are concerned about the poor quality of care. The third parties blame the doctors.

Caveat Patiens.” Patient, beware. An increasing number of doctors have succumbed to turning medical care into a business for profit.

The third parties have wrested control of medical care from the physician community and turned medicine into a free market commodity. This is an assault on medical professionalism and independence.

The Rationing of Medical Care

Thursday, October 1st, 2009

Rationing of medical care has existed in the US for many years, and the denial of its existence has been around just as long.

Most people in the general public don’t recognize rationing when it happens, and many health professionals refuse to admit to its use or disingenuously deny that it exists.

In the past six months, nearly every politician has mentioned rationing in order to deny that it will ever happen under the new healthcare system.  The fact that it already exists in the current system is unaddressed.

Rationing is a normal part of our lives.  Everyone uses it on a daily basis.  What is actually meant by the word “rationing?” When resources like money or food are in limited supply, they require sparing and prudent use – in other words, rationing.

For individuals in a group to conduct rationing on a fair and equitable basis requires what is called, “the ethics of distributive justice.” The group must create the rules of rationing, and must agree on how these rules will be applied. This principle applies in the rationing of medical care, but it has not been followed.

In the US today, the decisions about who will receive funding for medical care and who will not are made by (more…)

The Rationing of Healthcare for Profit

Tuesday, September 22nd, 2009

If medical care is an entitlement, our society cannot afford to pay for everything that is currently available. We need to set goals regarding who receives what care and for how long.

This requires rationing, by definition. In the US, rationing of medical care has always been with us. We are in denial, and we tend to avoid the term “rationing.” It’s perceived as un-American, so we refuse to acknowledge it.

One common method of rationing is by queue. People await their turn. Another method of rationing long in use in the US  is the limitation of  care through age discrimination. For example, organ transplants frequently are denied to those above a certain age.

Today in the US, rationing decisions are made by medical insurers based on profit motives. An individual’s healthcare needs are limited by the insurer’s financial goals. (more…)

Medicine’s Dirty Little Secret

Friday, September 18th, 2009

The proportion of the GDP that we spend today on medical care is already high, but it is just a fraction of what will be required in the future. Consumer demand and the continuing advances in technology will exert unrelenting pressure on medical costs.

Within this context, there is a huge push by many people for universal care provided by the government. We are the only country in the world that is applying the capitalistic, free-market approach to the delivery of healthcare. This commercial approach has limited our access to care.

Key questions about universal care include: How much care should be guaranteed? (more…)

The Health Rights Amendment

Monday, September 14th, 2009

To be perceived as fair in our egalitarian society, rights must be the same for everyone. Shouldn’t that apply to medical care as well?

Life is one of the inalienable rights set forth in our Declaration of Independence. But how healthy and how long a life is part of that inalienable right to life? The Constitution and Bill of Rights do not explicitly provide for health rights. Since this is not already covered as an American entitlement, maybe we need a Health Rights Amendment.

If everyone has the right to good health, this becomes a government fiscal responsibility. Our government, however, cannot possibly fund the good health to which everybody in the US may feel they are entitled today.

How should we define good health?  (more…)

Let’s First Define the Goals for US Medical Care

Monday, September 7th, 2009

Healthcare reform is being widely discussed right now, but the goals of our healthcare system are undefined! What are our actual intended goals for medical care in the US?

Are the goals to improve the population’s health, relieve pain and suffering, and prevent immediate death? Or do the goals also include satisfying everybody’s self-perceived wants to prolong meaningful life as long as possible by all available means? These are very different goals with very different implications for our healthcare system.

Prolonging meaningful life by all available means includes not only treatment with all available drugs and surgical procedures, but also replacing and mimicking all sorts of body-part functions with transplanted organs and artificial devices. That’s a very expensive proposition.

Do our goals include the prevention of all disease? (more…)

I Can’t Jitterbug Anymore

Monday, August 31st, 2009

Throughout my more than 62-year career in medicine, I have seen a steady decline in the level of personalized care that physicians give to patients. This is related to the significant advances in medical technology.

The story of my patient John Bongiovanni illustrates this very well. John owned his own food market. Shortly after he retired in his early 60s, he came to see me with chest pain. It came on occasion when he bowled, he said, and “I can’t jitterbug anymore,” he complained. He used to take his wife out dancing weekly.

Office evaluation revealed he had angina pectoris, which is pain in the chest from hardening of the arteries. He improved with medication and a change in diet.

I continued taking care of John, and became familiar with every aspect of his life. He came in regularly for checkups. After four years, John got worse. He had a heart catheterization and heart surgery. After the procedure, he returned to his activities without chest pain.

I took care of John for more than 20 years before I retired from patient care. (more…)

Universal Personal Care

Monday, August 24th, 2009

The concept of universal care is not a panacea, but it may be better for more individuals than what we offer today. Whether it is delivered by the government or by the private sector, however, it will be subject to political manipulation as well as exploitation by commercial enterprises.

One example of political influence that is already happening in government-sponsored care is that the Health Care Regions around the country have different Medicare reimbursement criteria for some of the same services. Much of this is the result of variations in lobbying success among regions.

The British health system often is held up as a model of universal care. Its apparent success in controlling costs since its introduction in 1948 is attributable to three major factors. (more…)