Healthcare legislation is presently being considered by Congress and the White House and some policy reforms are expected within the next few months. I expect that the details will be highly complex and the final thousand page proposals will probably contain many surprises. We are all familiar with the unsustainable growth in the cost of health care and health insurance, so some changes are necessary. In addition, the present system produces a lot of unnecessary anxiety which drives up overall health care costs. Our present per capita health care costs are higher than any other country, and our average outcomes put us well behind most other advanced countries.
I am by no means an expert but I’ll give my simple take on the basic problem: There are no major institutional parties in this country that have a real interest in health. Treating acute or chronic disease is the focus of our healthcare system. Indeed it would better be called a sick-care system than a health care system. Western medicine is wonderful at treating acutely ill cases and trauma, but not particularly effective at preserving and expanding health.
Individual people are of course interested in promoting their own health, but the major institutions involved in health care are not interested in promoting good health. The private insurance companies pass on all their costs and make extra profits by denying claims and cherry picking only healthy customers; the hospitals make their money doing acute care; individual MD’s generally mean well but are not reimbursed for time spent on educating patients and are themselves focused on acute care; and the pharmaceutical companies main interest is to have people take their drugs for long periods—healthy people are not good pharmaceutical customers.
I am hoping that the final legislation will include a strong “public option” and that this will eventually lead to outcome based standards determining which medical procedures are cost effective. These outcome based standards could in turn create a motivation to do more preventive medicine: “ A stitch in time saves nine” and “an ounce of prevention is worth a pound of cure” are two common proverbs for good reason: with more preventive care, the country could achieve much better health outcomes at a lower cost. If true outcome based standards are put into place, the utilization of alternative and integrative healthcare will increase, and overall health care costs will decrease. Right now the institutional incentives are all working the other way. There was an interesting article in the New Yorker recently discussing local health care differences and some of the institutional pressures driving up health care costs. http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
Of course, the real change that needs to happen is in the overall consciousness and understanding of people regarding wellness. For now, there are many individuals interested in health and wellness, but many Americans are still looking for the quick fix, the magic pill that will fix everything. After a few years, they come in to see us because they are taking six or seven pharmaceutical medications and feeling terrible. It would be far less costly to change behaviors and avoid the problems in the first place.
On a public policy level, most people want unlimited acute health care for a limited cost, and this is barely being addressed in the current proposals. It will be interesting to see what comes out of the legislative process with all the competing interest groups contending. I’m hoping for some improvements, even if the improvements are minor.
We definitely do need to transition from our present sick care system to a true health care system.