Doc's Thoughts on Healthcare

I promise I am not turning my blog into a political one. My husband wrote about our view on big government a few weeks ago and this post is about healthcare, but after this I'm sticking to babies, recipes, and all things good and light hearted. I just feel the need to vent now and then.

This is a very important week concerning healthcare since a new bill is coming out of its committee stages and being presented to Congress. These issues are personal to everyone, but even more so to those in the medical profession. Myself, a nurse. My father, a primary care physician who has been practicing for 20 + years. We have more than just our personal family healthcare plans we are concerned about. We are anxious to know how our careers, livelihood, bread and butter, and quality of life might be affected by this "change." (That is if the bill passes.) I think most healthcare professionals are burdened by what might be around the corner.

Throughout this national healthcare debate, I have heard many news reporters ask "Where are the physicians and why aren't they having more input?"

I can tell you why....THEY ARE AT WORK. Doctors are busy. They are delivering 14 year old's babies in the middle of the night, taking call on weekends, and sitting behind mountains of paperwork. And that is why we have not heard more from them about healthcare. I assure you it is not because they do not have opinions or because they agree with the proposed plans.

What I'm about to share with you below are just a few thoughts and ideas that my dad (Doc) put down on paper (per my request). I asked him to write up a little something about his views on healthcare for my blog. I think it is interesting to hear what he has to say since he has spent 20 + years in the medical field.

What he wrote only scratches the surface of A VERY COMPLEX ISSUE. It is not a finished product, but a FEW ideas and opinions. You may agree/disagree with some, none, or all of his thoughts. Hope it challenges you to question and think.

Me and Doc on the day of his medical school graduation, 1985

Doc's Thoughts on Healthcare
and a few old blurry pictures of me (SB) and Doc scattered throughout

1. Let insurance be insurance.

The real purpose of insurance is to share financial risk. The risks that we need to be insured against are those that are unexpected and catastrophic. It makes sense to have insurance to help pay for coronary bypass surgery, chemotherapy, or long term rehab treatments following a car wreck, but do we really need insurance to cover a sprained ankle, a case of strep throat, or routine childhood immunizations?

With insurance as the third party payer there is no incentive to hold down cost.

Health Savings Accounts would potentially provide a more efficient way of paying these costs than the cumbersome process of filing insurance. For every dollar we take in, about 15% goes to our billing and collections department. Health Savings Accounts, if designed correctly, could help prevent some of the siphoning off of health care dollars to the bureaucracy of billing and collections. It could also give individuals more choice in how they spend their health care dollars.

Who puts the money into these accounts-employer? individual? government? is the subject of a whole other debate.

2. Tax cigarettes out of existence.

If we become a nation of non-smokers tomorrow then we would see a significant decline in health care cost. Don't argue with me about this. I have already made up my mind.

If you look closely, you will notice the box says med school notes.

3. Learn a lesson from childhood immunizations.

Next to clean water and safe food supply, the childhood immunization program is the most successful public health program in our country.

One of the reasons it is so successful is because it is mandated. You can't send your child to day care, school, or receive WIC (Women, Infant, and Children feeding program), etc. if your child is not immunized.

We could provide a whole series of incentives using the carrot/stick approach to encourage individual citizens to live a healthier lifestyle which brings me to my 4th suggestion which is...

4. To provide financial incentives for individuals who achieve certain health goals or who undergo screening tests for various diseases.

Since physical health seems to be tied so closely to our nation's financial health, then why not attach a health form to the filing of income tax and give tax credits to those who achieve certain health goals? So if you were normal weight and underwent screening for high blood pressure, high cholesterol, diabetes, and underwent screening tests such as mammography, colonoscopy, PAP smears, and prostate cancer screening you could receive a personal tax deduction.

And those who receive checks from government entitlement programs (welfare, social security) could have the amount increased or decreased by a certain amount to incentivise the individual to achieve certain health goals.

studying

5. Cut out the duplication of government programs. I've worked in VA hospitals. I've never understood them. When I worked there we mostly took care of people who suffered from alcohol and tobacco abuse not for those injured or wounded in war.

VA hospitals are only convenient for those who live near them. If we as a nation decide that if you serve in the military then you should receive free lifelong medical care as a benefit, then why not just give all of our ex-military Medicare coverage and let them access their healthcare through the private system?

Why build a system and bureaucracy that duplicates what we already have and benefits those the most who are in close geographical proximity to the facility?

In our town we have an outpatient VA clinic, TRICARE (the active military insurance), Medicaid, Medicare, and various "free" clinics funded by various government grants. There are other programs for Native Americans, federal employees, etc. all funded by the federal government.

This is a very patchwork approach to healthcare.

I am a strong proponent of the KISS system (Keep It Simple Stupid) when it comes to configuring a government healthcare system.

Fewer programs, fewer bureaucracies, and less duplication should result in some savings.

6. Develop a medical court system to handle medical malpractice cases. There is no way a jury of 12 people who have no medical training or experience and who have never worked in healthcare can understand the complexity of medical decision making or understand the risks of treatment vs. non-treatment or the potential hazards of various procedures, etc.

For the physician, there is no such thing as a trial by a "jury of your peers." Besides being potentially unjust, medical malpractice is fueled by the greed and finances of trial attorneys.

Are there bad outcomes as the result of bad care? Yes, but a more just, reasonable, less expensive, and less adversarial forum needs to be provided to adjudicate these and there needs to be the input from those in the medical profession when decisions of guilt or innocence are made.

Our current system is very costly, ties up the regular court system, and results in a lot of nuisance suits with with no foundation and results in over testing and over treating because of the practice of defensive medicine.

It seems as though the current administration wants us to duplicate the medical system of Europe and Canada. I'm curious as to how those countries handle the issue of malpractice. I literally have no idea, but I wonder if the president is so committed to the European style of medicine is he equally committed to to the European style in handling malpractice?

His patients will be comforted to know that he really studied . Always in a book.