Health Care: What Single Thing Would You Change?
From the vantage point of this Blog, the state of our health care system ranges from the totally remarkable (advances in body imaging and cancer therapies) to more evil than the drug-lord tactics of nearly every insurance company and pharmaceutical company that make the Columbian Cartel look like the Vienna Boys Choir.
What do you do when nearly every aspect appears to require a major overhauling? Do you scrap the system? Do you make small changes? Do you have a philosophy of building or do you overlay a regulatory estate on the system -- sort of like "Big Brother meets your local doctor or hospital"?
As with many things in our daily lives that seem too complex to take on there are times when the adoption of a single event places us on the road to recovery. On a personal level it can be leaving that dead-end job you had and starting over. Maybe it's something as simple as cleaning off your desk. Whatever it is, the road to success starts not with a single step, but with an index moment. What is an index moment? It is a behavior or event that as time marches on you look back to the index of your life and see that event as a critical juncture where significant change began.
What Will be Our Index Event for Health Care?
Here is the challenge. There are a lot of smart people out there. Actually there are too many smart people out there. There are too few people with common sense. But a helluva lot of freaking smart people. The smart people outline, in article after article, ALL the problems with our health care system. The problem is that they are right. Every one of those articles has important points for us to ponder.
It really doesn't matter since we all have so much time to ponder health care anyway - the wait to get precertification for 4 extra physical therapy visits from our insurance company can take weeks, approval for surgery from the Worker's Compensation Board takes months, and doctor office waits, maybe longer.
Boy, do we have a lot of time to ponder these questions. That is why doctors' offices have so many magazines - to feed into our need to ponder these great dilemmas. The reason we need to ponder these is because since no one has the courage to DO a single thing to effect change (writing is not doing by the way) we are left with pondering. Let's ease off on pounding the pondering and figure out what we can do.
Is it Just One Thing? Maybe...
I think we all believe in the following statement:
If this one thing just changed in health care then we would be significantly better and on the road to recovery.
What is that "one thing"?
I asked a colleague this question recently. She was trained as a radiologist and ranks as one of the smartest doctors I ever met. She felt that if she had to change just one thing in medicine she would improve the environment for medical students coming out of medical school so that it would be more attractive to want to be a doctor. She feels that many of the best and brightest of our college graduates are not going into medicine because of the problems in the system and that any solution to health care must make sure that it is an attractive enough field to bring those people back in.
I agree with her, although the definition of "attractive" can be complex. Does this mean more money? More jobs offers? Tort reform (the changing of the medical malpractice system)? Either way, her point is that the destruction of the health care system will really be felt in twenty years when the current group of doctors will have some voids of talented people who went to other endeavors.
Recently I read a few articles by Atul Gawande, the respected health writer and author of the recent book Better. Since the end of April, Dr. Gawande, who is also a surgeon who practices in what appears to be an academic-based practice through a hospital system, wrote fourteen columns or reviews in the New York Times alone. All of them excellent and insightful. Dr. Gawande writes in other venues as well, so in a year he produces for us an encyclopedia of the issues that are presented to us in health care today. Read what he writes. You may or may not agree but it will clearly bring you up to speed on the major issues in front of us.
If reading Dr. Gawande's work was enough then we can stop there. No way, Jose. It is not that simple. The range of Dr. Gawande's work is massive, covering topics from access to HIV drugs to problems in the elderly related to nursing homes to hand-washing in hospitals; almost like a medical Wikipedia in action.
Unfortunately, like the movie said "there are a thousand stories in the Naked City...this is one of them..." applies to the American health care system. We are a complex melting pot of needs, special needs and special interests. We are a country with a deep attachment to civil liberties and the needs of the individual. That is not necessarily the case around the world.
In a recent NY Times article Dr Gawande makes reference to an important study performed by The Commonwealth Fund that showed our health care system is the most expensive but our life expectancy is the same as Australia, Canada, New Zealand, Germany, and Britain. While we don't appear to fare well against these countries in some areas, we excel in others. The take-home lesson is that what is important to Americans may not be as important to citizens of these other countries or to the authors of these studies.
That leaves us here, on this blog with one goal.
If you can do JUST ONE THING to change health care, what would it be? Just one thing. Not two, not three, not 28 million. One thing.
Here are a couple of ideas (not necessarily mine but ones that have floated through this Blog over the past year) but there are obviously more:
Post away, baby....
Dr. K.
Related Topics: Technorati Tags: healthcare reform, health and wellness
What do you do when nearly every aspect appears to require a major overhauling? Do you scrap the system? Do you make small changes? Do you have a philosophy of building or do you overlay a regulatory estate on the system -- sort of like "Big Brother meets your local doctor or hospital"?
As with many things in our daily lives that seem too complex to take on there are times when the adoption of a single event places us on the road to recovery. On a personal level it can be leaving that dead-end job you had and starting over. Maybe it's something as simple as cleaning off your desk. Whatever it is, the road to success starts not with a single step, but with an index moment. What is an index moment? It is a behavior or event that as time marches on you look back to the index of your life and see that event as a critical juncture where significant change began.
What Will be Our Index Event for Health Care?
Here is the challenge. There are a lot of smart people out there. Actually there are too many smart people out there. There are too few people with common sense. But a helluva lot of freaking smart people. The smart people outline, in article after article, ALL the problems with our health care system. The problem is that they are right. Every one of those articles has important points for us to ponder.
It really doesn't matter since we all have so much time to ponder health care anyway - the wait to get precertification for 4 extra physical therapy visits from our insurance company can take weeks, approval for surgery from the Worker's Compensation Board takes months, and doctor office waits, maybe longer.
Boy, do we have a lot of time to ponder these questions. That is why doctors' offices have so many magazines - to feed into our need to ponder these great dilemmas. The reason we need to ponder these is because since no one has the courage to DO a single thing to effect change (writing is not doing by the way) we are left with pondering. Let's ease off on pounding the pondering and figure out what we can do.
Is it Just One Thing? Maybe...
I think we all believe in the following statement:
If this one thing just changed in health care then we would be significantly better and on the road to recovery.
What is that "one thing"?
I asked a colleague this question recently. She was trained as a radiologist and ranks as one of the smartest doctors I ever met. She felt that if she had to change just one thing in medicine she would improve the environment for medical students coming out of medical school so that it would be more attractive to want to be a doctor. She feels that many of the best and brightest of our college graduates are not going into medicine because of the problems in the system and that any solution to health care must make sure that it is an attractive enough field to bring those people back in.
I agree with her, although the definition of "attractive" can be complex. Does this mean more money? More jobs offers? Tort reform (the changing of the medical malpractice system)? Either way, her point is that the destruction of the health care system will really be felt in twenty years when the current group of doctors will have some voids of talented people who went to other endeavors.
Recently I read a few articles by Atul Gawande, the respected health writer and author of the recent book Better. Since the end of April, Dr. Gawande, who is also a surgeon who practices in what appears to be an academic-based practice through a hospital system, wrote fourteen columns or reviews in the New York Times alone. All of them excellent and insightful. Dr. Gawande writes in other venues as well, so in a year he produces for us an encyclopedia of the issues that are presented to us in health care today. Read what he writes. You may or may not agree but it will clearly bring you up to speed on the major issues in front of us.
If reading Dr. Gawande's work was enough then we can stop there. No way, Jose. It is not that simple. The range of Dr. Gawande's work is massive, covering topics from access to HIV drugs to problems in the elderly related to nursing homes to hand-washing in hospitals; almost like a medical Wikipedia in action.
Unfortunately, like the movie said "there are a thousand stories in the Naked City...this is one of them..." applies to the American health care system. We are a complex melting pot of needs, special needs and special interests. We are a country with a deep attachment to civil liberties and the needs of the individual. That is not necessarily the case around the world.
In a recent NY Times article Dr Gawande makes reference to an important study performed by The Commonwealth Fund that showed our health care system is the most expensive but our life expectancy is the same as Australia, Canada, New Zealand, Germany, and Britain. While we don't appear to fare well against these countries in some areas, we excel in others. The take-home lesson is that what is important to Americans may not be as important to citizens of these other countries or to the authors of these studies.
That leaves us here, on this blog with one goal.
If you can do JUST ONE THING to change health care, what would it be? Just one thing. Not two, not three, not 28 million. One thing.
Here are a couple of ideas (not necessarily mine but ones that have floated through this Blog over the past year) but there are obviously more:
- Universal health care insurance supplied by the government
- Complete restructuring of medical malpractice
- Nationalize the drug companies (treat pharmaceuticals like natural resources such as oil from the Alaska pipeline)
Post away, baby....
Dr. K.
Related Topics: Technorati Tags: healthcare reform, health and wellness
