Are doctors a solution to what ails the US healthcare system? Many areas of the country need medical care that's not available to them. Will the healthcare reform have any impact on the problem of soaring medical costs and quality of medical care in the United States?
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Are doctors a solution to what ails the US healthcare system? Many areas of the country need medical care that's not available to them. Our US health industry accounts for 1/6 of our economy ($2.5 trillion). Will the healthcare reform have any impact on the problem of soaring medical costs and quality of medical care in the United States?
A battle for health care system redistribution will result in a bruising fight. Access to top doctors, cutting edge procedures, and advanced lifesaving technology, deal with the quality-of-life issues a doctor considers when deciding where to live, and more importantly what will his income be?
REGIONAL PHYSICIAN DISCREPANCIES
We have created a nation of areas that have great health care and other areas that have none. This problem is likely to grow because doctors gravitate to affluent localities in the United States that have more than the medical help they need.
Doctors locate in coastal counties where the weather is fine and the living is great. Orthopedists, urologists, and obstetricians are hard to find in areas where the heat is oppressive, the air quality is poor, and insurance reimbursement is difficult. The coastal area is massively over served by doctors, while the nation’s most depressed regions along West Virginia coal mining states are at the mercy of the medical community.
As doctors cluster together, health care costs soar. This does not result in better outcomes in cities with large physician populations. The healthcare package talks about expanding benefits to uninsured patients, but does nothing about cutting medical costs. Now that health care will be available to 46 million more United States citizens, and new taxes are levied on the rich, will this disparity in medical care be changed?
PHYSICIAN DISTRIBUTION
For every doctor who lives and practices in a poor area, four other doctors settle in an over served area. This poor distribution of our valuable and expensive healthcare resources has put great strain on areas that need doctors. Neonatologists don't settle where the need is the greatest, and cardiologist don't go to areas where there are high rates of heart attacks.
Areas lacking in physicians offer visa assistance for foreign doctors and medical school repayments to entice doctors to practice in those areas.
UNNECESSARY TESTING
Is medical care better where doctors are abundant? In areas that have a great abundance of doctors, patients are more likely to receive more unnecessary procedures and tests. More doctors are associated with higher costs of care and more procedures that don't really help patient medical care. High-cost states, like New York, are loaded with more patients getting admitted to hospitals, and who receive a battery of tests and treatments. Poorer areas must rely on primary care doctors to keep patients out of the hospital.
FEE FOR SERVICE
The “fee for service” structure rewards specialists for performing complex procedures. Primary care doctors who practice preventive medicine don’t get any monetary rewards. A primary doctor sees about 35 patients a day and makes $150,000 a year. A brain or heart specialist makes four times that salary for performing complex procedures.
FOLLOW THE MONEY
If Obama is right, and it's true that $500 billion of dollars of costs can be eliminated through improved efficiency, rather than through government spending, from where will he cut this waste? How will this be affected? There certainly will be consequences in any attempt to reform healthcare distribution.
The reform package is talking about expanding benefits to uninsured patients rather than cutting costs. We certainly must invest in more doctors and have additional costs to cover the 46 million added to the insured patient payroll.
Are we willing to take funds away from high-cost cities like Los Angeles and New York and give underserved cities more money? Will we let urban hospitals struggle to care for the high percentage of uninsured patients that they have been treating in the past?
If Congress talked about pulling a third of the money out of the health care system they would've lost the support of the pharmaceutical industry and the American Medical Association. Hence, the White House has decided to concentrate on talking about medical access to avoid alienating key industrial city allies.
It's hard to imagine that any health reform is going to have an impact on the soaring medical costs and uneven quality of care in the United States. Quality care should be reworded with good outcomes and not just more care.
Just because you've increased insurance coverage, we have not addressed the dilemma, nearly 50,000,000 people have.
Not every small hospital can practice like the Mayo Clinic. If we slowly improved health care efficiency, with time, we could get appreciable quality results. By pushing hard changes quickly, we risk triggering a wave of hospital bankruptcies.
WHY IS CANADIAN MEDICINE SO GREAT?
IT'S NOT! Canadians complain about long waits for elective care, including appointments with specialists, and selected surgical procedures. There are shortages of Canadian doctors and nurses, especially in rural areas. The growing cost of covering an aging Canadian population keeps increases.
As we American spends 16% of our income on health care, the Canadians spend only 10%. However Canadians have a tax rate of 48% of their income, mainly to fund their health care system. Canadians wait longer, than in Britain and Australia, to see specialists or to receive elective surgery. They wait 17 weeks for a specialist referral, compared to 12 weeks ten years ago. In England, no one over 59, can get a stent, or a heart bypass because “it is too expensive and not needed”.
As you approach 70, the health reform will probably tell you to discontinue some of the treatments you are now taking. The government feels this money can be spent better on someone with greater longevity than you. Twenty five percent of Canadian patients complain about unacceptable long waiting for non emergency surgery. Rationing occurs with coronary artery bypass, hip and knee replacement, cataract surgery, and radiation treatments.
Canadians now allow private medical insurance for services covered by the government, and they also allow doctors to charge patients extra fees. They buy supplemental private insurance through their employers for eye care, dentistry, and outpatient prescription drugs.
Many lawsuits have been instituted in Canada, claiming these lengthy waiting lists violate their basic rights under the Canadian Charter of Rights and Freedom.
Outgoing Canadian Medical Association President, Robert Quillet, said: “there is a urgent need to fix the Canadian healthcare system, and Canadians must stop deceiving themselves into believing they have the best healthcare system in the world.
COMMENTARY
The health reform bill has provisions to ration senior healthcare. Former Sen. Tom Daschle, who authored this part of the bill, and says “health care reform will not be pain-free and seniors should except the conditions that come with age, instead of asking for treatment for these conditions”. You will be encouraged to end your life sooner than you wished. As you grow incapacitated and increasingly ill, you'll find it more difficult to keep yourself alive.
You'll be encouraged to draw up advance directives, have a power of attorney, a do not resuscitate order, and other documents to express your wishes.
You will be asked who's is authorized to make critical decisions for you? Medicare officials will propose ways of measuring the quality of end-of-life care, and doctors will get financial incentives to report this data to the government.
The House bill provides medical coverage for optional consultations with doctors who can advise you on health sustaining treatments and end-of-life services, including hospice care for you. Pay consultants will encourage you to accept approaching death, rather than receive costly medical procedures that could extend your life.
Interestingly, congressmen and senators have their own health care plan that is very local pay, and guaranteed for the rest of their lives. They will not give up this plan nor be a part of the new plan they are proposing for us.
WHAT DO YOU THINK? YOUR COMMENTS ARE ALWAYS APPRECIATED.
Visit www.drneedles.com for more medical commentary on controversial medical health care issues.
Source: DARTMOUTH ATLAS OF MEDICAL CARE DATABASE
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