This is the first of a four-part article that will be posted on Goanet for general information. Constructive comments are most welcome; and will help me polish this article before I send it for publication.
Comprehensive Healthcare - Empowering the front-line of Medicine. Gilbert A. Lawrence, MD, DMRT, FRCR, Utica, New York Much debate in the US currently underway is about "healthcare reform." Yet, to-date the discussion is on the easier aspect - outlining a payment mechanism for medical care. Without belittling the brilliant minds, the present discussion on "health-insurance" reform is a semantic issue aimed to slice and dice the payment mechanisms for the cost-pie of healthcare. Yet, it is the US economy that pays for healthcare of its citizens. Congressional and town-hall debates are only about pathways to channel dollars from economic-production (measured as GDP) to healthcare-consumption. Intermediaries between the funding-source and the end-user merely consume resources (dollars) along the way, add turbulence and impede the smooth flow in the healthcare delivery pipeline. As an example, while Medicare administrative cost is 2% of premiums, insurance companies consume 13% as administrative cost. The extra costs stems from advertising and marketing; actuaries to write insurance policies, lawyers to deny claims and defend decisions; and an understandable complex and legitimate corporate structure, including share-holder services and dividends required from all corporations that are traded on Wall Street. Additionally there are corporate decisions on investments, take-overs, mergers, lobbying of politicians, outside consultants, bankers, lawyers, etc. - all paid for by healthcare premiums. The current debate is important for health insurance reforms to provide near-universal coverage, elimination of restrictions like pre-existing illness, guaranteed choice of coverage, affordable and portability insurance, and long-term financial stability of the Healthcare system. etc. The Issues Lest we ignore the issues at stake, here is an over-view of the current conundrum. Healthcare is in a critical condition resulting in 52 million uninsured and under-insured people, ballooning federal budget deficits, the cause of a lackluster economic competitiveness of the country, and the overall negative effect on business-viability and rising unemployment. A 1% rise in unemployment results in a million people without health insurance. The 2.4 trillion dollar cost of medical care consumes 17% of our GDP, which is 30% more than our economic competitors in the developed world. If we only match the closest competition, 6% of GDP or 800 billion dollars a year, now spent on healthcare, could be saved with better health-outcomes. Healthcare costs have precipitated bankruptcies for a growing number of individuals and families, small and large corporations (including domestic auto companies), threaten city, state and federal governments and the healthcare industry. Per-capita, the cost in US is twice that of "peer" countries. High medical costs trigger high premiums, stagnant wages, exclusion of those with pre-existing conditions, and a higher deductible and co-pay for those with insurance. Currently politicians and town-hall emotional debates are about the payment system - how healthcare should be paid for. Despite the emotional rhetoric, this has little impact on delivery of care; other than, as shown above, siphoning-off dollars from the more important issue - patient care. The present system is a cascading cycle, devoid of any accountability. This was well depicted in Dr. Gawande's study of medical care in McAllen, Texas. His report rightly, although solely, blames doctors for the very high cost of care in one of the poorest regions of the country. The report overlooked the facilitating roles of administrators of hospitals and nursing-homes who choose to "go with the flow," the insurance companies who waited for more than a decade to investigate the shifting practice-patterns, as well as organizations that accredited nursing homes, hospitals and their various specialty-departments which, in part certified their practice patterns. The individual failure of all these resulted in a "cumulative act effect," using Reason's hypothesis for "System Failure."
