Those who try to solve health care don’t know the reality on the ground

Because I wrote my book, I was recently asked to summarize the health care crisis. I have focused almost 25 years of research and writing about health care on what is happening on the ground, every day, with doctors and patients. I’m not an economist or financing expert or technology geek, so I can’t offer anything there. I am a practicing psychologist with advanced training in health care research and policy. In my opinion, what is missing from the national conversation is a combination of avenues of inquiry which would offer a unique perspective integrating research and policy with what is actually happening on the ground with health care.

Health care in our country is deathly ill.  We spend too much money for inferior health care. The destruction of the doctor-patient relationship, combined with restricted access and resulting declining quality of care are some of the most visible symptoms of the crisis. The root is the insurance companies, which are gigantic profit making benefit denying behemoths. And yes, of course, some problems are not caused by the insurance companies, but this is not a reason for deflecting blame from them.

Restricted access is a problem across the board. The health care benefits of the working poor, the poor, and minorities have continued to decrease. People with public insurance such as Medicaid and the ACA often aren’t covered adequately or can’t find care. Medicare has increasing restrictions and people purchase additional coverage if they can afford it. In fact, the Zarephath Health Center has donated thousands of hours of health care to people who “should” have coverage through these plans, but don’t have it. People with private insurance see denials and often absurd, arbitrary, refusals to cover purchased benefits.

Denial of mental health benefits is part of this national tragedy and disgrace. Research shows that mental health care can reduce loss of work productivity, lead to appropriate decreased use of medical care, increase personal responsibility and improve quality of life. Mental health care also intersects with medical care. People do not make decisions rationally. Emotions have an influence on if and how we seek care. There are problems such as “frequent flyers” or over-utlizers, who need triage and direction to other avenues for help and under-utilizers who actually need to be encouraged to seek appropriate care. A fair amount of the former present at our ER’s, where it is inordinately expensive to treat them. The doctor-patient relationship also has an emotional component, as do all relationships, but it is the key to quality medical care. A solid doctor-patient relationship improves compliance, improves quality of care, improves patient (and doctor) satisfaction, and decreases lawsuits, never mind improving health. This all saves money.

Just as our doctors are demonized, it’s easy to demonize our hospitals and rail against the cost of a Tylenol, the “chargemaster,” or the proliferation of MRI machines, to name a few out of context examples. What about the strangling regulations and the stifling insurance denials? The truth is that many of our hospitals have gone under and the rest of them are struggling to survive. Merging, among other advantages, gives them more leverage with the insurance companies, which in some instances are then rendered obsolete. Again, no doubt there are problems. And there may be other problems with emerging large hospital systems. But I have yet to see a realistic analysis of what it actually takes to run a high caliber hospital. Someone must know and this needs to be part of the national conversation.

As someone who trained in academia for many years, I am dismayed to see well-intentioned bright minds postulating theories and models which have little to do with the day to day reality of health care on the ground. The same is true of some of the nationally proposed plans. If only we could harness these resources and work collaboratively! There are groups working in a collaborative and bipartisan way. Some have on the ground knowledge. There are several national conservative physician groups. Think tanks and organizations such as the American Psychological Association, Rand, Kaiser, AARP,  American Academy of Family Physicians, and the RWJ Foundation analyze policy and make recommendations. In fact, even with my years of work on health care, I don’t analyze policy myself. I rely on these resources. It’s too complicated with too many intertwining factors and long histories.

There are other issues such as how to handle legitimate malpractice claims and differentiate them from frivolous ones. We need to explore possible solutions for evaluation of quality of care, access, and existing pitfalls to current methods. But the immediate priority is to improve quality of care, increase access, and return decision making to our doctors. Our lives depend on it.

Peggy A. Rothbaum is a psychologist and can be reached at her self-titled site, Dr. Peggy Rothbaum.  She is the author of I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship.

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