by Gary R. Gibson, MD, FACP
We can deliver better health care to every U.S. citizen at less than one-half of 2.1 trillion dollars per year with constructive reform, a system wherein people receiving and providing care would feel greater satisfaction and dignity. Through courage and perseverance, we must identify and minimize waste, eliminate corruption and modernize our system. In a competitive world economy, we must reform health care effectively, or lose our position as a world leader.
In 1983, the seventeenth year of Medicare, administrative costs of the program were about 4%; stated another way, 96% of all Medicare money paid directly for health care. In 1983, “managed care” was introduced: Medicare checks stopped going to patients and began going directly to insurance companies. Currently, over 30% of health care expenditure (equal to 5% of U.S. Gross Domestic Product) goes into health insurance companies and never comes out again. These investor-owned health insurance companies should receive zero tax dollars, but rather earn clients through direct solicitation.
Health care reform will fail if we continue to pretend insurance companies manage care. They don’t manage care; they manage money and reward investors. The 25 year experiment with private insurance taking taxpayer dollars and not spending them efficiently has been a calamitous failure. It is time to turn a deaf ear to their lobbying influence, turn a page, and look to other world democracies for innovative, relevant examples of efficiency and quality. All administrative costs in U.S. health care should be below 3% of total health care expenditures.
Medical tort reform should ensure that 90% of monies exchanged in the malpractice system go to victims/families. Currently, victims/families of malpractice recover less than 40%, while 60% goes to insurance companies, attorney fees, and expert witness fees. Other democracies have methods worthy of study to design a better U.S. malpractice system.
Doctors, nurses and pharmacists must be trusted to do their professional best in patient care and not be distracted by third party directives. Doctors in primary care and most direct patient care practices should not be employed by hospitals as this too often conflicts with their oath or obligation of patient advocacy. No insurance company or benefit manager should tell a doctor, or other health provider, how to care for a patient. Such directives ignore the fact that the doctor is responsible for proper care and are in violation of a sacred covenant that is as old as civilization itself.
Drugs must be priced transparently so market forces can allow competition – without hidden rebates, pricing schemes or benefits conditional upon mail order. Pharmacy benefit managers must be eliminated altogether as they serve no useful purpose, only precipitating higher costs to patients and payors as well as interference with doctors and pharmacists who serve patients at the point of care.
The Federal Trade Commission must intervene to prevent actions patently injurious to the public health, such as Bristol-Myers Squibb’s 2007 payment to Apotex halting production of the generic drug clopidogrel and Pfizer’s 2008 accord with Ranbaxy preventing the introduction of atorvastatin to the U.S. until November 2011. The Medicare prescription drug benefit (Part D), enacted in 2005, has not made prescription drugs more affordable because of the profound influence lobbyists from the pharmaceutical industry and pharmacy benefit management companies exerted over Congress in writing the law.
We must retreat from the obsession with more tests, more drugs, more specialist opinions and more consumption of resources that relentless advertisements in the media are telling us we need. The “medicalization” of normal or benign physiological and psychological life processes has created insatiable hunger in the minds of millions, and it is making us more anxious, not healthier. When patients have been enticed by these solicitations, they are less likely to accept reassurance based upon a history and physical examination, and less able to objectively evaluate scientifically valid health care information.
The U.S. pioneered information technology, but lags behind other countries in utilizing the computer for storage of valid health information for doctors, nurses and pharmacists at the point of care. We must develop a national medical database, written and accessible by doctors and other providers at the point of service. Such a database will serve not only the individual patient but also to accelerate the evolution of clinical research. It would hold accountable all providers who author information therein. Currently, computerized templates are too often used to generate longer records to enhance hospital or provider reimbursement, implying a more comprehensive level of service. Such perversion of information technology adds noise to the medical record, not information. We must use this tool wisely.
Anyone rejecting national administration of taxpayer health care dollars should remember it was just that model of government funding and oversight that brought about such scientific and engineering feats as the Panama Canal, the interstate highway system, NASA and our modern military. We have an army of doctors, nurses and pharmacists as skilled as any in the world. They are trained and willing to fight against human suffering and disease. The war is perpetual and their battles are ours. Now is the time to excuse the lobbyists and work together to build a better health care system.
Our elected leaders in Congress must wash their hands to prevent the further spread of greed and corruption which has infected our health care system in recent years, and made sick our entire U.S. economy.
Gary R. Gibson is an internal medicine physician.
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