The Mayo Brothers
Our health care system is in critical condition, and Congress and the Obama administration have the opportunity to put it back in the recovery room. Here are the key issues I would like to see in a final health care bill.
1. Shift the debate from saving money to saving lives.
Currently, our health system is designed for disease care rather than health care. Instead of focusing on keeping people healthy, the system would rather focus on treating disease and illness, often prolonging the unprolongable. For example, Medicare provides reimbursements for lab tests and x-rays only when the doctor issues a diagnosis. As a physician, I find that totally backwards –– I order tests to determine a diagnosis, rather than the other way around.
If the taxpayer is to be burdened with the cost of health it should be better that what we already have. We must have a system that advocates reasonable age- and gender-specific health screenings for all people beginning as early in life as possible. Recently, recommendations have come out against prostate cancer screening, colonoscopies, and routine physicals, largely for cost reasons rather than any concern about health. One article even recommends mammography beginning at age 50 instead of 40 years, contending we can save billions. But at what price –– a woman’s death? In other words, it is cheaper to let you die.
2. Find a way to control the costs of all health services.
Health care in the United States costs more than it does any other country. Why? Because we can and do charge more –– not because it costs more. Here’s one example: Treatment for breast cancer in the U.S. can run north of $60,000 while the same treatment in Buenos Aires is only $4,500. And yes, health care businesses tend to focus on profits rather than providing actual health care.
We are looking for ways to reduce cost by reducing services, when we should instead be looking for ways to reduce the cost of services. For example, an MRI of the brain can cost between $480 and $2,200 –– in the same unit with the same protocol. If insurance pays for it, the price can be discounted to around $950; if Medicare pays, it can cost $600. But if a patient walks in with no insurance, he may be expected to pay the whole $2,200. Cost musts be uniform and transparent. If cost is the problem, then it is cost we should fix. End of story.
3. Administrative costs must be contained.
Administrative health care costs exceed 35 percent of the entire health bill –– that’s 30 cents of every dollar. That includes the obvious excesses, like enormous marketing budgets for the latest brand-name drugs and multimillion dollar bonuses and compensation packages for health-care executives. But it also includes the costs in doctor’s offices, such as staff members who do nothing but process insurance paperwork and all of those nameless, faceless people at the insurance companies who accept or deny your claims. Patients receive little benefit from these exorbitant administrative costs.
4. Outlaw exclusions for preexisting conditions.
Insurance companies must be required to cover all individuals regardless of their history or preexisting conditions. Additionally, insurance premiums should reflect costs over an entire risk pool of patients, whether it be a national or statewide pool.
5. Fix the way physicians are paid.
The current system pits the physician’s financial interest against the best interests of his patients. Most doctors are currently paid through a “capitation” model, in which an insurance company or HMO pays them a set fee per patient (or per head, hence the term “captitation”) per month. Doctors are expected to take care of all patients and even cover costs of extra tests and specialists. But the truth behind this model is that doctors make more money by doing less for their patients. This system does save money, but it has a huge cost in lives.
Another problem is that doctors get paid more for doing things (procedures) to people than doing things for people (consultative services). This has driven new doctors away from primary care specialties –only about 2 percent of new graduates are entering primary care. New models of reimbursement –– like the salary models at the Mayo Clinic –– must be examined and put into practice.
6. Provide access to everyone.
Our leaders must build a system that allows access to everyone. It must also allow choice –– if individuals want to opt out and seek care from physicians through regular insurance, they should be allowed to do so. Right now, who gets health care is decided by who does or does not have insurance coverage. Another way to say is that the system caters to the haves (those with resources) rather than the have-nots (those who are underprivileged). I believe we would be better off if we provide services to those who want to be healthy –– for instance, those who want to exercise, control their weight, not smoke, and get checkups –– versus those who do not get it.
7. Malpractice reform is necessary.
Tort reform is talked about a lot, but it may not be the best solution. In Texas, tort reform has succeeded, thanks to caps of around $250,000 on noneconomic damages. Yet in many cases where the lawsuit is meritorious, the injured party is undercompensated. What may surprise many people is that more than half of all the money expended in the legal process before tort reform went to the legal process instead of to the injured party. One of the big problems is that many jurors do not understand the technical and legal issues in medical cases. Setting up a system in which a group of knowledgeable arbitrators can hear these cases would go a long way to stopping all of that waste.
8. Use preventive care to deal with end-of-life issues.
Many people die in nursing homes after a long, slow decline, and everyone says, “It’s a blessing, he/she is no longer suffering and is better off.” But I would argue that a long, slow decline is not good enough. We should be doing everything we can early enough in life to ensure that we stay healthy and active as long as possible.
The goal should that one night when we’re quite old, we go to bed fully functional, perhaps embracing our loved one, and gently wake up dead. If our health care system were designed to get people to that point, we would all be better off when the end finally does come. I, for one, hope that happens to me, and I’d like to see that for everyone.
re: #7 Might we also look at blocking frivolous lawsuits from the patient end by making more info available up-front (or at least without filing a lawsuit)?
http://www.motherjones.com/kevin-drum/2009/09/real-cost-medmal
What you say here makes sense to me, but I’ve lived my entire life on the receiving end of the ‘script’ pad*, and what Kevin says makes sense to me, too.
*I have never worked in a health-care-related field.
“Shift the debate from saving money to saving lives.” Agreed.
It reminds me of an interview I heard on KUT, with two area pastors who talked about the “human” aspect of the whole health care issue. An online blurb summarizes the interview: “They say the suffering they have seen under the current system should be a catalyst for honest debate and action.”