Solving The Health Care Crisis
I anxiously await hearing what solutions Washington comes up with regarding our Health Care nightmare. I realize this is a bit of a different blog, but I did practice Internal Medicine in Santa Monica for 25 years. I also admitted hundreds of patients to the hospital. I have witnessed for many years the extreme waste within the medical system.
Two of my children are in Health Care. One is a third year resident in Anesthesia at UC San Francisco and one is completing her first year of medical school at USC. I was talking with them the other day about their feelings regarding waste in the system. After speaking with them, I decided to bring up a very, very delicate issue. My daughter has become fully aware of this problem in less than one year of her training. I have now seen this for 30 years.
The issue is all about “rationing” care. Rationing simply means giving more care to some and less care to others. Rationing is nothing new to anyone. Nearly everything in our lives is rationed in one way or another. With regard to healthcare, we have elected as a coutry to ration care based upon social and economic status. So, we have over 40 million un-insured and tens of millions more receiving less than standard care.
Medicine needs a bailout just like the rest of the country. It has been overspending resources and very poorly allocating valuable resources. We have to begin to choose as a country how we spread our resources. Medicine is like everything else. So, the question is, are we happy with what we have? If not, we have to begin changing how we spend our assets of money, equipment, personel, hospitals, vaccines, bypass surgery, joint replacements, etc.
When there were inadequate number of kidneys for transplant, committees decided who got the kidneys. The same happened with bone marrow transplants. Now there are inadequate resources available in nearly every area. We must change our rationing position. I believe we need to look at end of life spending on truly hopeless cases. We spend 95% of the Medicare dollars in the last several years of life. Perhaps this should be looked at?
We all realize what I am referring to and it is so painful. On the other hand, do we really want to keep our ICU hospital beds full and neglect basic vaccines and preventive care for young and productive individuals? No other country in the world gives out unlimited care to everyone; we certainly don’t either.
Where should the resources go?
5 Responses to “Solving The Health Care Crisis”
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Great blog, yet another great post!
What area of medicine have you been in? I know we never speak about these issues outside of the medical “back rooms”, but if we are going to “fix” the system, we must make these tough decisions. Thanks for your thoughtful comment. Allan
I agree 100% regarding Electronic Health Records. I use a system I built myself for practicing cannabis medicine. I have actually been very, very active for 19 years in building several large systems that are still running at both UCLA and Kaiser.
So, the records help a lot, but the HUGE dollars required to keep end of life patients alive represents a significant part of the Medicare dollar. Allan
That’s an interesting viewpoint, and not one I’ve heard before. It does seem like preference should be given to areas where the money will go the farthest and do the most good – i.e. preventative care on the under-50 set.
But I’ve heard from other medical professions that one of the biggest areas of waste is the lack of computerization of patient records. I have an HMO myself and everytime I have to visit a new doctor it seems like I spend countless hours filling out forms. There are already gigantic databases that store all sorts of our info, why do I have spend an hour filling out forms everytime I go and visit a doctor?
Dr. Frankel,
This is certainly an uncomfortable subject for many to broach in the healthcare reform debate, but I think it is absolutely critical. Having been involved in Healthcare for the past decade I too have seen firsthand the waste and misallocation of resources. From purely an economics perspective, one must ask where the resources need to be directed. If you were investing in the infrastructure of your business you would no doubt invest in those areas that would yield the greatest return. Although it may sound or appear callous, we must address issues such as end-of-life treatment, with a similar ROI framework at hand. With universal coverage, at the expense of taxpayers, becoming more a probable reality, an examination of the maximum utilization of our healthcare dollars must be undertaken. Simply stated, although the preponderance of healthcare dollars are spent on the elderly, this is not necessarily the populace that will give society the greatest return for their dollars invested. I agree that astronomical amounts are currently being spent for “hopeless” cases where the statistical probability of cure or improvement in quality of life is extremely low. Many practitioner’s order needless tests, administer unnecessary drugs, and perform treatments just because there is a CPT or DRG that medicare or other commercial insurers will reimburse. I believe a good start to the conversation is to develop a model whereby practitioners have more skin in the game and can share in the economic losses that occur if substandard or unnecessary care is delivered. Conversely, higher quality levels of care delivered at profitable, and system sustaining levels, would be rewarded.