Welcome to “Health Care’s Broke,” my series of thoughts on what’s ailing the health care system, and what needs to happen to solve the problems we’ll face in the next century, as we face an aging population and workforce, a changing physician workforce, and new technologies and therapies that improve the lives of patients. Our health care system was created to deal with the acute illnesses, while our patients and providers now deal with chronic ones. Our health care system — and few others in the world — have adapted in response.
I’ll be tackling everything from health care financing to HIPAA and privacy, from malpractice to direct-to-consumer marketing, and everything in between.
The goal? To create some constructive dialog from both sides of the political aisle on what should happen. And to that end, I welcome your comments, but only if they’re of a constructive nature. While my undergraduate background was in Health Policy, and my graduate training is in Medicine, I make no claims to be the ultimate in health wonkery. To that end, I’d love to hear why you think my ideas would or wouldn’t work, or how they might be improved. They are, to some degree, brainstorms straight from the Half-Bakery, and while I think many are unique or different from what’s already been tried or suggested, maybe they’re brilliant. Maybe they’re idiotic. I am simply trying to understand why each of the players in the health care system act/behave as they do, and then provide possible fixes based on these motivations.
I’ll be posting one to two topics a day, if I can keep up. (I already have 9 written.) I look forward to the dialog. My goal is to keep it as apolitical as possible, focusing on the health care side of things as much as possible. But again. It isn’t a political diatribe. It’s a series of reasoned arguments to provide health care resources to those who most need them.
The perspective I take here is a mix of wonk and physician. In some areas, I may see more of the individual physician’s or patient’s perspective. In others, I may look more toward what would be best for society, not best for each individual person: patient or physician.
I am also a firm believer in the fact that if we do not make efforts to change, progress, and improve in areas that we know can and need to be improved, Congress or JCAHO or some other regulatory body will step in and pass some probably-well-meaning but ultimately-terrible-for-docs-and-patients law to try to remedy the problem themselves. Privacy was a concern of patients, doctors didn’t do enough to self-regulate, and we got hit with the hell that is HIPAA.
Regulatory bodies and Congress are, for the most part, reactionary. If a problem comes up, and is not solved, they will respond by imposing regulations. Look at any JCAHO regulation, and I guarantee there’s a history behind it. Do I think that a nurse and a doctor can’t talk to each other over the phone without a verbal readback by the nurse? Of course not. But somewhere along the way, enough verbal orders got screwed up that someone decided to do something about it. Why do chart regulations now stipulate that you have to write out morphine, instead of MSO4? Because doctors’ handwriting was bad enough that people were getting magnesium instead. I dislike regulations entirely, and don’t believe that an administrator at a desk knows more than I do about taking care of the patient in front of me, but if those of us in health care aren’t critical of ourselves in figuring out what’s going wrong and how we can fix it, inane, silly, wasteful and potentially dangerous regulations will keep coming down the pipeline.
I do not believe that just because doctors mostly control health care (really, we do) we have the right to be stuck in our ways while every other industry adapts and progresses. I understand the reasons behind stuck-in-our-ways, but they seem to be a bit out of sync with the 21st century.
Why Am I Doing This?
We spend plenty of time debating health care financing (which is certainly important), but as many people have already noted, we have many other major issues in health care that aren’t being addressed or even discussed. While Americans view health care as a major issue, the presidential candidates (and politicians in general) have largely ignored anything besides health care financing. So I figured I might as well try to do something about it.
And with that, we’re off to the races with one of the least publicly-discussed and probably most important topics for the next 30-plus years in health care: End of Life and Futile Care. To keep up with the series, they will all be listed in their own category together if you please.
(Note: if you’re interested in linking to this series, I’d love the help getting the discussion going! Copy this code below to your blog, and it’ll link to the category archive with the image and look like this: