Here are my next two principles of affordable healthcare reform.
First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it serves.
In healthcare delivery, quantitative must be balanced by qualitative. Specific community needs and the culture of that particular community must have equal and in certain cases, greater value than the numeric and economic efficiencies that must be addressed.
The hospitals where we work and the processes that we as physicians, nurses and other providers utilize must be rebuilt and redesigned and executed consistent with available technology while utilizing the human capital necessary to achieve the best medical outcomes measured as a function of their cost over time. Our outcomes must be measurable, scalable and reproducible to achieve the greatest medical results per healthcare dollar spent. The left hand should always know what the right hand is doing. Computerization, if it truly can be integrated, should be fully utilized to maximize the outcomes of cost-efficiency, optimal clinical outcomes and a fully integrated database to allow for continuous improvement in what we do and how we do it.
We can now perform most of the procedures done in a large community hospital in smaller facilities at a significant reduction of fixed costs. These procedures can be done more efficiently as well. The infection rates can also be lower if the small ambulatory hospitals strictly follow CDC and CMS guidelines. When you couple these savings with insurance bundling for the commonest surgical procedures (rolling up the numerous different billing codes used to invoice a surgical or a medical procedure into just one code covering all relevant costs) the savings would run into the hundreds of billions. The current American hospital is inefficient and over-built for today’s medical needs. Anyone who has walked down the endless corridors of hospitals that have been repetitively updated since the 1950s or 1960s or 1970s to try and find the right place to go knows what I mean.
Next, all members of Congress, their dependents and all federal employees must live under the same healthcare rules that they themselves impose upon others.
Prior to the passage of the new healthcare law, Congress was shamed into changing its content as they sought to exclude themselves, their families and their staffs from the provisions of the law. Fortunately, someone read the Bill before it was passed, discovered this arrogance and deceit and Congress had no choice but to then include those they sought to exclude.
There is no point in commenting upon this vile act of chicanery other than to say it is consistent with the new rules of public behavior; that is, if you can get away with it then you can do it! What it does show is that if you live by the sword, then you die by the sword. If you impose policy and rules upon those from whom you derive power, then you too need to follow those rules. You too need skin in the game and this would also include your pension plan as well. Maybe then, just maybe, congressmen and senators will actually read the bills they pass and impose on us. Maybe now we will no longer be spoken down to and dismissed by informing us that we will know what will be in the Bill when the bill is passed.
Mitchell Brooks is an orthopedic surgeon and the host of Health of the Nation on Talk Radio 570 KLIF in Dallas, Texas. He blogs at Health of the Nation.
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