Republicans sabotaging America’s health-care interests

By Robert D. GILLETTE

The Vindicator

The Affordable Care Act (sometimes called Obamacare), which was recently passed by the U.S. Congress, is a much-needed step toward reforming the American health-care nonsystem. However, it has become the object of ugly, misleading and often untruthful attacks by its opponents.

Sad to say, Republican congressional leaders have made it clear that their top priority is to embarrass the president by torpedoing the new law, thereby boosting their political power while sabotaging our nation’s interests.

This obstructionism has already created problems in terms of the quality of the Affordable Care Act. If the Republicans had pursued a responsible course while the bill was being shaped, there could have been agreement on many points and a shared quest for compromise on others. In the end America got a good reform act, but not an excellent one.

Rising costs

Let’s recall why reform is so urgently needed. The overall cost of medical services in the United States is more, per citizen, than that of any other industrial nation. These outlays have been increasing at more than twice the rate of inflation for many years, and they are projected to explode even faster in the near future. This scary trend has multiple causes including the aging of our population — people need more and more expensive medical care as they get older.

This situation might be tolerable if the claim that America has “the best medical care in the world” was true, but it isn’t. Looking at life expectancy, infant death rates, overall patient satisfaction and other measurements shows that several other nations rank higher. Also, about one in every six Americans lacks medical insurance altogether, a cruelty that other developed nations would not tolerate.

Hard evidence from solid research shows that many of the dollars spent for medical services are wasted. Every year some diagnostic or treatment method that had been accepted on flimsy evidence gets shot off its pedestal by reliable research that should have been done years earlier. This wastefulness is driven in large part by the powerful “medical-industrial complex,” giant for-profit corporations whose savvy representatives sell drugs, supplies and high-tech equipment to a system where effective cost control is often lacking.

The indifference to costs can be illustrated by the experience of a middle-aged man (a Federal employee, by the way) who consulted his primary physician about some strange spells he was having. The doctor felt that the symptoms could be caused by either a neurological disorder or heart disease and initiated referrals to two specialists. Careful history-taking would have revealed that the spells were typical of a minor seizure disorder and that the patient had suffered significant head trauma playing rugby several years earlier. There were no other symptoms consistent with a heart problem, and his family history showed no cardiac disorders looking back three generations. The heart workup, which was done first, was completely normal. A later neurological evaluation led to a diagnosis of — yes — a minor seizure disorder.

Very big problem

The point is that the same outcome could have been achieved at much lower cost if the most likely diagnosis had been addressed first. That would have saved the taxpayers the five-figure price of a fruitless heart evaluation. This is only one small symptom of a very big problem: just as no raindrop sees itself as contributing to a catastrophic flood, few medical professionals grasp the importance of their practice styles in America’s medical cost crisis and act accordingly.

That must change, but how? It will require a combination of approaches, many of which are addressed in the Affordable Care Act. These include support of electronic medical record systems so doctors can see how their practice style compares with best practices, and more targeted research that gives them definitive, unbiased information about what works and what doesn’t.

The act addresses other important aspects of cost-effective comprehensive patient care: periodic health screenings, immunizations, and counseling about diet, exercise, stress management and tobacco avoidance. These are “win-win” programs: they help people live longer, healthier lives and they reduce medical costs. The act also addresses the serious shortage of primary care physicians and other professionals who play such an important role in keeping small medical problems from becoming big ones.

Complex, far-reaching

A new program as complex and far-reaching as this one cannot be put into action just by the stroke of a pen. Some initial parts of it were activated last month. Others will start up in stages over the next couple of years. Detailed information about this process is available at www.healthcare.gov.

Robert D. Gillette MD is a retired family physician who resides in Poland.