Fragmentation is behind health care’s biggest problems


My friend Jeremy went to an emergency room with belly pain, and soon learned he’d been blessed with a kidney stone. The staff summoned a urologist, but none was available, so they sent him home with a pain prescription. Continuing nevertheless to writhe in agony, Jeremy phoned urologists and learned to his dismay there were only three in the region who accepted his insurance, and none at all in his county.

The next day, he painfully drove thirty miles to see one of those urologists, who recommended lithotripsy, a treatment in which ultrasound shock waves shatter the stone. But this doctor couldn’t get access to his hospital’s lithotripsy machine for two weeks. He recommended that Jeremy go home, take the pain meds, and hope to pass the stone. Jeremy phoned his local hospital to ask whether this doctor could do the lithotripsy there. No, administrators said, since he wasn’t a member of that medical staff.

So here was Jeremy, an insured, otherwise healthy patient in the world’s richest country, left to squirm with a curable condition even though treatment was locally available. Luckily for him, he passed the stone. A week later.

He has nothing but praise for the medical people he dealt with. “They treated me wonderfully,” he says, “but the system is so hobbled by its minefield of rules that to someone sick it feels cruel to the point of evil.”

Health care’s ludicrous expense is so garish that we ignore a serious and related defect, its fragmentation. It’s owned and operated by government agencies and scads of competing for-profit corporations that each maintains their own proprietary contracts, policies, and procedures, their own data systems, and ethical codes. It’s hard enough being sick without having to navigate this impossible kaleidoscope.

Let’s be clear: It’s not us medical practitioners who have knotted up our health care system. We’re healers — when we’re allowed to do it. The problem is that the people who pay us don’t know and could care less what actually happens in an examining room. Their bottom line isn’t ours.

We can reform this wasteful mess by integrating health care into one coherent system that’s motivated not by profit, but by service, as we’ve done with our fire departments, public schools, and libraries. Taiwanese citizens, for example, simply slide their government-issued card through a scanner to access health care that’s rated higher than America’s, and operates at a third of the cost per person (and at a tenth of our administrative costs). But something similar won’t happen here without our loud and determined voices.

Jeff Kane is a physician and is the author of Healing Healthcare: How Doctors and Patients Can Heal Our Sick System.


View 27 Comments >

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories