In
My Opinion: American Health Care, What Do WE Believe
By
ALLAN DOBZYNIAK, MD
The idea that free markets cannot correct the broken aspects of the
US health care system and only government can deserves analysis and
debate.
Those
who rail against the defenders of a market-based health
care evolution use a standard group of repetitive and emotional
arguments that are largely flawed.
1)
There are 45 million uninsured in this country. In fact,
15 million choose not to purchase health care insurance
because financially they do not need it. Fifteen million
can afford coverage but choose not to purchase it. That
leaves 15 million who are truly needy. The question to
ask then: Is it necessary to nationalize everyone’s care
or should the focus be to our social obligation to this
specific minority?
2)
American health care outcomes are no better. In fact, survival
rates from leukemia, breast cancer, colon cancer and heart
disease are better in the US than in Canada or Europe.
Also access to dialysis and necessary cardiac interventions
is greater in this country.
Infant
mortality as a measure of health care quality is not justified.
It is rather a social and political issue like substance
abuse, seat belt use, or obesity and hardly the fault of
health care access or delivery.
3)
Do not express opinions unless you have solutions to all
health care issues. It would be my hope that no single
individual would claim such omniscience or that they or
a small group could have such hubris of thought. The issues
need to be framed, ideas scrutinized, facts substantiated
and conclusions validated through well informed public
discourse. Emotion, politics and haste should not drive
the outcome.
4)
Health care inflation exceeds that of the rest of the economy.
Health care is hyper-technologically driven. The care given
10, five or in some instances even one year ago cannot
be compared to care associated with the burgeoning knowledge
and technology supporting present care. Vigilance must
be exercised such that capital can continue to be appropriately
allocated to allow unimpeded medical progress. Markets
allocate capital best. Government is great at the three
R’s: restricting, restraining and regulating.
5)
Free markets do not work for health care. In fact, they
have not been tried. In the 1960s Americans paid one of
every two dollars spent on health care. Presently they
pay one out of every seven. Of interest is that individual
cost has gone up almost exactly in inverse proportion to
this ratio of dollars spent. Of similar interest is that
families with “free” health care spent 40 percent more
than families with some form of cost sharing, with no difference
in health outcomes. The lessons are that markets belong
to consumers (patients) and this is an untried approach.
Where consumers have had market opportunity, value has
resulted. Value is defined as best cost, quality and service.
6)
An optimal, successful model for government health care
exists. This actually poses the question to the non free
market group. Please show me that universal, centrally
managed, government health care system that demonstrates
excellence; or propose one.
7)
Even the present system that is faux capitalism has resulted
in amazing medical marvels in diagnosis and treatment.
Imagine what appropriately unfettered free markets and
proper capital allocation could bring to the future of
the world’s health care. Remember, it has been the United
States that has been the hub of medical progress.
Given
the projected $50 trillion entitlement shortfall, the aim
of government will be to contain health care costs. A valid
assumption would be that cost control would lead to restrictions
on the pace of technological progress by rationing its
use and artificially controlling its price. Look at Canada.
This
brings us back to the questions of what is right and what
do we believe. What is right is not too complicated. The
health care system should allow access to affordable, quality
health care for all Americans. It should support the core
precept that health care is fundamentally a personal relationship
between patients and doctors.
What
do we believe? My strong personal belief is that the medical
community must be positioned around principle. There are
core beliefs that all physicians can rally around because
they can and they should. To be swayed by politics, populism,
hubris or personal hidden agendas will degrade the poignancy
of the profession. It seems obvious, but is almost never
addressed: a strong, ethical, confident, motivated and
healthy medical profession is mandatory for the health
care excellence Americans deserve. The health and professional
satisfaction of physicians, as well as other health care
providers, must be a consideration, or any prospect of
true excellence will be an illusion. The health of the
medical profession is integral to the health of patients.
As I have stated and implied in the past, all changes proposed
to health care need context relative to their effect on
the profession and its ethical foundation. The medical
profession should not be responsible for the exclusive
design of a new health care delivery system but must assume
a prominent advisory role. As physicians do with their
patients, they must do with the American populace. It is
imperative that they educate, advise and help guide good
decisions by Americans who should directly own a new model
for health care. The outcome should provide the foundation
for not only continuous improvement in customer (patient)
value but also for physicians and others committed to patient
care.
Here
is a comparative list of a health care system predominantly
market based versus one that is government based.
Market
Based:
the system is owned and controlled by patients.
Government Based: The system is owned and controlled
by government.
MB:
There are tax incentives and credits for the purchase of
private insurance.
GB: Financed by higher taxes.
MB:
Health care decisions are made by patients including insurance
choices and ownership as well as provider (physician) choice.
GB: Health care decisions are made by a central
authority (Mr. Daschle’s Federal Health Advisory Board).
MB:
Providers and insurance companies are accountable to patients.
GB: Central (Board) accountability to Congress.
MB:
Value (cost, quality, service) driven by market competition.
GB: Pricing, cost sharing and quality driven by
regulations and madates.
MB:
Capital is properly allocated, rewarding successful outcomes
and stimulating technological progress.
GB: Capital allocation is determined centrally,
including amount, to whom and for what, with cost flattening
restricting medical progress (government tends to reward
failure, i.e., the TARP program).
MB:
Markets provide for rational purchasing and pricing.
GB: Since entitlements disconnect the payer from
the consumer, pricing and purchasing then become arbitrary
and centrally controlled.
MB:
Professional satisfaction is implicit to excellence in
an accountable, competitive market.
GB: The medical profession is controlled by regulations
and mandates. Pricing is arbitrary and centrally determined.
MB:
There is marketplace innovation sensitive to patient-driven
quality outcomes.
GB: There is no incentive to market innovation.
Central focus will be cost control. Any quality initiatives
will occur via bureaucratic gamesmanship with pricing
control the underlying goal.
The
demagoguery of our present health system has been deafening.
Certainly change is needed. But change must include a revitalization
of the medical profession, otherwise it is only an illusion.
There can never be excellence in American health care without
a vital and fully engaged medical profession. In the past,
physicians were generally upbeat. Given the incessant assault
on doctors, no wonder the pervasive gloominess that now
seems their mantra. I sometimes believe there is the thought
that physicians are irrelevant to health care. Most obvious
though is the better and more enthusiastic are physicians,
the better the system. Any compromise in physician quality,
satisfaction or engagement will be reflected in progressive
deterioration of all aspects of health care.
Change
to American health care does not need to be a nationalized
health insurance system. It is possible to advocate for
a free market solution that would be infinitely better
than the doom implicit in a Washington-run, bureaucratic,
centrally dictated health care system.
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