Story posted Wednesday, August 26, 2009
Health Care Reform & The Long Road Ahead
By MAUREEN PEKOSH Contributing Columnist
Healthcare reform has been dominating the headlines. Too many Americans do not have health insurance. Too many Americans are choosing to forego medical treatment, doctor's visits, and tests because they cannot afford the price. Healthcare has become too expensive - there is no one arguing that point. The debate rages because it is difficult to agree on how to provide adequate care cost effectively.
This summer we met some children with diabetes whose families did not have any health insurance. These children obviously were hospitalized at some time when their diabetes was diagnosed. Since that time were they regularly seeing a qualified doctor to monitor their care? Were they getting their blood sugar levels checked with a special test that truly measures their long-term control? This test usually requires a blood draw at a lab, but more and more doctors are paying for an expensive machine in their office so the test can be done in real time during a patient visit. Were these children getting ongoing education about counting carbohydrates, calculating insulin amounts, exercising, and treating blood sugar highs and lows? Were these children even getting the daily insulin they needed? They were not wearing insulin pumps to deliver their required daily insulin, even though numerous studies have shown that continual insulin delivery from a pump usually provides better blood sugar control. Were these children getting the best care? Were they even getting just the absolute necessary care? Shouldn't they be entitled to the best care because they have diabetes and do not want to have to deal with any of its complications? Shouldn't their care be determined by their illness and not their ability to pay?
Healthcare reform is critical in that a diabetes diagnosis should not be a pre-mature death sentence for any child just because of lack of insurance. However, having had to live with a child who struggles to manage diabetes daily, I do not want to give up any of the more expensive techniques we have been lucky enough to employ that have improved her level of care? There has to be a way to deliver both basic and specialized care to those who truly need it while managing the associated costs.
The debate has largely raged over whether or not there should be a public provider - should the government provide something similar to Medicare to those who cannot afford insurance but are not old enough to qualify for Medicare? A public provider would not reject people who have pre-existing conditions like diabetes. A public option would not refuse to cover those who are unemployed. A public option should truly be looking at medical need.
Yet many fear that a public provider would reimburse doctors and hospitals at a much lower rate. Doctors and hospitals still would need to cover their costs and might then increase the costs those with private providers must bear. Businesses might find it advantageous to eliminate their private insurance and have their employees join the public option, which businesses would help support through some special tax. The problem with this debate is it only focuses on one half of the problem. It does not address how to bring down the cost of providing health care.
Our economic crisis was predicated by greed. Individuals and organizations took advantage of market conditions, inside information, or situations for personal gain. The same is true in healthcare. Costs have escalated because profit has been put before healthcare provided in too many circumstances. The debate should be on how to fix a system that is broken rather than on how to continue funding a system that will bankrupt us all.
Doctors provide a specialized service and deserve to be reimbursed accordingly. There are only relatively a handful of people who are qualified to successfully perform open-heart surgery. There needs to be incentives for young people to put in the time and money to become qualified doctors. Yet once a doctor is practicing, it seems wrong that they should be able to profit by sending patients to certain centers for care or by referring special tests or specialists. Healthcare providers should not seek personal gain when prescribing certain medicines or courses of treatment. Healthcare providers should first and foremost provide wellness for their patients.
Ever since I was young, I thought of the Mayo Clinic as the best medical provider. When my grandfather was diagnosed with colon cancer over 35 years ago, everyone told my grandma he needed to go to the Mayo Clinic. Mayo Clinic is not just a leader in medical treatment; it is an innovator in managing medical care costs.
At the Mayo Clinic, doctors earn salaries. They meet in teams to study and discuss best practices, needed improvements, and individual patient cases. It seems almost counterintuitive, but at the Mayo Clinic the best care is being provided at less than average cost. This seems to be because the best care is not about quantity but quality. Doctors are meeting together to determine what is best for a patient rather than ordering every test possible because of a concern about possible liability. Doctors are not incented by compensation for any particular decision, procedure, or referral. Doctors are patient focused. Somehow the mentality there is not about making as much money as possible but about providing the best care reasonably.
Providing medical care is a business just like providing groceries or clothing. Retailers who provide quality merchandise at a reasonable cost are probably finding it somewhat easier to stay in business during these challenging economic times. If the merchandise was of lesser quality, was priced too high, or was considered frivolous, individuals are probably spending less of their precious dollars on it.
Most individuals spend their health care dollars on care they consider necessary because of their doctor's advice. If doctors suggest tests that are not really necessary, or hospitalizations that are not required for the patient's best health, they are needlessly increasing the cost of healthcare. It is not just doctors but individuals throughout the chain of healthcare suppliers that might be taking advantage of the existing system, needlessly adding costs that they believe no one will really notice for personal gain. Those costs are adding up and hurting us all.
Defining necessary is a huge task. When my daughter's insulin pump was recently stolen, it was apparent that while we liked using it and thought her blood sugar control was better, it was not the only alternative she had to get insulin. She could easily begin taking shots again every day. When she visits her endocrinologist, we can tell by reviewing logs of her blood sugar readings how she has been doing in general. Her doctor performs an additional blood test in his office because it tells about her blood sugar over the last few months both when she did and didn't test. It is more accurate of a reading of her blood sugar control. We leave the office knowing we are doing well or with a new insulin regimen that our doctor believes will offer better control.
My daughter could also wear a continuous glucose monitor that would give her a blood sugar reading every minute. This would help her avoid all the blood sugar swings and the unnecessary blood sugar highs and lows she deals with every day. She has lived without it until this point but there is not doubt her control would be better with it. It is an expensive device that some insurances have agreed to pay for because they believe the investment up front will pay off by alleviating unnecessary costs from complications in the long run. However the device needs to be worn continuously and used correctly to truly pay off. If patients receive such a device but do not use it properly has it now become a needless medical expenditure further draining our scarce medical resources?
I believe most doctors do truly want to deliver the best medicine to their patients just like I believe most business people want to honestly earn a profit. I believe doctors and patients must work together to define medically necessary. It is my hope that the definition takes into account both the long and short-term implications of any treatment. While I do not think that having the government run healthcare will lower the costs, I do think that there needs to be defined standards of treatment for common conditions so medically necessary treatment is more easily defined and less easily abused. There will undoubtedly be the cases of diseases where multiple tests, hospitalizations, surgeries and special procedures will be warranted to provide the best care for a patient. No one should profit from all this medical intervention - it should only make the patient healthier. If we continue to fund unnecessary treatment for more people, we will only be pushing our healthcare system to the brink that much sooner. Until we can stop the needless procedures that are increasing the costs of medical care, we cannot hope to spend more money to provide more care to the uninsured and underinsured. Viewing medical care as a personal piggy bank is really just robbery - it takes away someone else's ability to receive legitimate care.
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