Health-care reform is falling short

By ROBERT D. GILLETTE MD

The current state of health-care legislation in the U. S. Congress is comparable to that of a football team that leads 7-0 at the end of the first quarter of a big game. It’s a good start, but not yet a victory for the American people. The U. S. Senate and House of Representatives have passed legislation calling for major reform, but big differences between the two bills remain to be resolved. Neither version deals adequately with the huge system problems that make American health care so costly while perpetuating flaws that make the claim that we have “the best medical care in the world” seem like a bad joke.

A half century ago, when Medicare was being debated in the Congress, about 6 percent of the dollars spent in our nation went for health care. The numbers for 2010 will be about 18 percent, three times as much as in 1960 and continuing to rise at a frightening rate. This hurts all of us in ways that we may not recognize. You didn’t get the raise you deserved last year? Perhaps your employer had to spend that money on escalating premiums for your health insurance. Your town’s schools are suffering because state funding is disappearing? Maybe the difference is being used to cover constantly rising state Medicaid costs as well as medical insurance for state employees.

The news isn’t all bad. Americans benefit greatly from our medical system. People live longer and are healthier in their senior years than in the past. However, other industrial nations do it better, with lower per-person costs, and they don’t leave a sixth of their people uninsured and dependent on crisis-oriented charity care. Only in America do staggering medical bills lead to thousands of personal bankruptcies and home foreclosures each year.

The issues that remain to be tackled are mostly about money — incredibly large amounts of it, aggressively pursued by a range of special interests who will continue to suck massive profits from our financially inept medical system until the rules of the game are changed. The annual cost of health care in the U. S. is more than $2 trillion — that’s a 2 with 12 zeros after it. Evidence keeps piling up that about one-fourth of that amount is wasted on futile procedures — things that don’t actually help patients. Think about the benefit Americans could receive if $500 billion were put to better use each year.

Some suggestions

Here are some concrete steps toward making the U.S. health-care system more cost-efficient and more responsive to the real medical needs of the American people:

First, push harder for more research into what works and what doesn’t. Protect the people and organizations that do such studies from coercion exerted by businesses and politicians seeking to distort or suppress the results.

Second, expect physicians, medical institutions and patients to act in response to the best available information, not just bowing to “expert opinion” or advice from those who stand to gain financially from certain tests and treatments.

Third, continue and augment efforts to get people to exercise more, eat less and avoid tobacco and other health-destroying products.

Fourth, move away from fee-for-service medical care, which can lead doctors and hospitals into wasteful ways of treating patients. Encourage newer group practice payment methods that get better results at lower cost.

Fifth, rein in our clumsy, wasteful tort law system, for three big reasons: more than half of the dollars paid for medical liability insurance end up in the pockets of lawyers, not claimants; fear of being sued often pressures doctors and hospitals to order excessive tests and treatments, and many people with valid grievances lose in court while others with baseless claims win big (or at least their lawyers do).

Sixth, revive primary care medical practice (disclosure: this writer is a retired family physician). As Samuel Taylor Coleridge said two centuries ago, “Every reform, however necessary, will ... be carried to an excess that itself will need reforming.” The move toward medical specialization that began after World War II was necessary and beneficial, but it has been carried to an extreme, creating a fragmented, bewilderingly complex, impersonal medical system. It is rife with duplication of services and missed opportunities to keep little problems from becoming big problems. It is time to embrace the “medical home” model in which general physicians and their associates provide routine medical care and arrange efficient, effective specialist services when that can help patients.

X Dr. Gillette, a retired physician and emeritus professor of family medicine at NEOUCOM, maintains an active interest in health care system issues. He lives in Poland.