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Healthcare Forum Review and Commentary

 by Charlie Naef  August 5, 2009

An unscripted panel of four healthcare professionals -- a nurse, a private family practitioner, a hospital physician, a surgeon who is president of the Madison County Medical Society -- offered valuable insights into the weaknesses of our nation's fractured, overly complex, inefficient and costly healthcare delivery system -- or lack of system in the words of one panelist.

The first speaker recounted from personal experience how some fifty years ago one went to a doctor’s office or the doctor would make a home visit when one was ill.  The patient paid the doctor in cash.  Penicillin was the wonder drug, there were fewer hospitals, most people died at home.  Compared to now, healthcare delivery was simple, readily available, and relatively inexpensive.  Nevertheless President Truman had asked Congress without success to pass a national health insurance bill.  Other attempts at the time of the Nixon administration and later in the early Clinton administration also failed. 

 Now with nearly 50 million uninsured and millions more of underinsured Americans, the panel supported universal healthcare, ideally under a national government sponsored single-payer insurance system that would dramatically reduce the current exorbitant administrative costs of private insurance. 

Astounding medical advances that save and extend lives in our country and abroad have contributed to the dramatic increase in healthcare costs.  The fact that in the United States one out of six dollars of national spending goes for healthcare, and in the absence of radical reform is projected to rise in a few years to one out of five, places too heavy a burden on the economy that places us on a competitive disadvantage.  This exceeds significantly what is spent per capita in other industrialized countries, many of which provide their populations with better and more equitable care.  That is why our national healthcare delivery system is broken.

A panelist who as a representative to the House of Delegates of the New York Medical Society, which presents its recommendations to the Governor and State legislature, reported that New York State was close to enacting an universal healthcare law before the new Obama administration decided to address the problem on a national level.

The panelists agreed that all Americans should have access to a trusted primary care physician of their choice.  As healthcare gatekeepers, primary care physicians should offer preventive care leading to healthier lives, diagnose and prescribe for treatable diseases, keep complete up-to-date electronic records of every patient’s medical history in an universally transmittable form, order routine tests and referrals to surgeons and other specialists.  In the imagery of one panelist, the primary care physician is the conductor of an orchestra of specialists.

Universal healthcare requires a far greater number of primary care physicians who are already in short supply in rural areas.  Currently new physicians, who enter their profession with a mountain of medical school debt, are encouraged to choose specialty over primary care medicine, because the latter practice is inadequately reimbursed by insurance.  Improved universal primary care will in the long run significantly reduce the nation’s total healthcare costs, but it requires basic changes in the way medicine is practiced.  The lack of tort reform to reduce the prohibitive cost of malpractice insurance also places a heavy burden on the medical profession.

The panel agreed with questioners from the audience that mental health deserves as much attention as physical health and should be equally covered by mandated insurance plans.

While public discourse tends to avoid sensitive issues, especially end-of-life treatment that claims one-quarter of the nation’s insurance dollar, the panelists insisted that such issues must be addressed honestly and candidly.   A kidney transplant for a terminally ill cancer patient is absurd.  Not only is hospice care more humane, it is far less costly than hospital care.      

Nor did the panel and contributors from the audience duck the issue of rationing healthcare.  Rationing that emphasizes quality over quantity of procedures and rewards outcome will improve the nation’s health is essential to controlling skyrocketing costs.  Currently most of the rationing is done by Medicare and private insurance bureaucrats, all too often in an arbitrary, profit driven fashion.  An independent commission of healthcare professionals should review annually unnecessary and ineffective medical procedures and prescriptions. Congress should then be required to vote the package of its recommendations up or down, just like recommendations from the Military Base Closing Commission.

Rationed time did not permit addressing President Obama's cautious, politically dictated approach to require near universal coverage while keeping intact the multiplicity of Medicare, Medicaid, Supplemental Children's Health Insurance Program (S-CHIP), VA healthcare, and employer-based for profit and not-for-profit insurance plans, the latter covering about one hundred million people.  Everybody should have a choice of plans applicable to them, including a new public plan that would pressure private insurers to lower costs and subsidize the population segment that doesn't qualify for any of the existing public plans and cannot afford private insurance.