Healthcare Reform

Everybody is talking about reforming medical care system in the US. So, I’ll put in my two pence.

Why are we having such a problem in the first place?

I think it is pretty simple: everybody seems to push for what’s best for themselves at the expense of the society:

* The primary purpose of healthcare plan carriers is making money. Patients are second. Of course, they’ll disagree with me…
* The primary purpose of pharmaceutical companies is making money. Patients are second. Of course, they’ll disagree with me…
* The primary purpose of many (not all) doctors is making money. Patients are second. Of course, they’ll disagree with me…
* The primary desire of many patients is getting as much as possible for as little as possible, most of the time without having clear idea of what they need and why.

As to the healthcare plan carriers, I’m afraid I must claim insufficient understanding of what the possible options to change the situation are, but I have a feeling it includes some form of public coverage, not because it will be a great quality coverage, but because its executives will presumably be less preoccupied with making profit, which may reduce costs and increase competition. Maybe I am just naïve.

As to the pharmaceutical industry, it is engaged in largely unethical deceptive marketing of many expensive, ineffective and often harmful products to the population which has been brainwashed by said marketing. This is truly a bad situation. Multitudes of people are hooked on huge numbers of drugs which should not have been started in the first place, but now it may be too late to stop some of them. Drugs are pushed at the expense of healthy living and other common sense measures. The expense of this charade is abominable. The drug company money is so interwoven into every nook and cranny of society, that it influences all healthcare decisions being made on all levels. For example, they support doctor “education”, “patient advocacy groups”, and even their regulators, by paying a half of FDA’s budget (talk about a fox guarding a chicken coop!)

Inexpensive alternatives are always suppressed and expensive ones are touted. For example, most of drug medicine can be done with drugs available from Walmart for $4 a month. Yet, we are encouraged to prescribe alternatives costing $100 a month. Herbal, nutritional and homeopathic alternatives are publicly laughed at, though in many cases they would be much cheaper and more efficacious. Life style modifications are always mentioned to maintain political correctness, but not supported, so they almost never work. The most promoted treatment modalities are always those that will net the pharmaceutical industry the most profit.

Now to doctors. Many (not all) always want to do whatever brings them most money. Expensive high-tech procedures are preferred, even when better and cheaper alternatives are available. Of course, some procedures and tests are necessary, but probably less than half of what is being done. For example, many orthopedic surgeries are done at great expense, though their results are not as good as some innovative forms of physical therapy and chiropractic costing an order of magnitude less. Expensive unnecessary tests are carried out all the time: MRIs, EMGs, CTs, etc. Many of them don’t change management of the patient, so why do them? Somebody is making a buck… Of course, if the doctors in the trenches, especially the primary care ones, did not have some ways of making money in addition to just seeing patients, most of them would not be able to survive. There is just not that much money in seeing patients, especially on welfare plans or Medicare. So we improvise… unfortunately not always in an entirely ethical manner. One of my colleagues once told me: “You want to do what? Ethical medicine?! Forget it, it no longer exists!” Sad!!!

And the patients!.. Unfortunately, most of them are a bunch of people knowing only enough to be dangerous. They hear something somewhere (like some deceptive advertising), and they think they need it. The truth is they don’t have a clear understanding what that thing will really do for them. Of course, you can’t blame them… Much better educated people are working on manipulating their thinking day in and day out. You can’t expect everybody to just start researching everything for themselves and distrusting everything they hear. But this is exactly what needs to happen. You can’t trust anybody! Read all above and you’ll understand why!

How do we fix this? Well, first of all, let’s get the fox out of the chicken coop. Then, we need to do proper comparison studies of all available methodologies (not just those most profitable to their developers) and educate the populace about the results of the studies. We must insentivize the public to choose the most effective and cost-efficient healthcare modalities by making everybody interested in saving money going towards their treatment. This probably means higher deductibles for everybody, but I am not an expert on financial solutions. One thing is sure: my cash-paying patients are tremendously better educated about their healthcare than those who don’t care how much their care costs. They ask great questions, we have much more productive discussions, they are much more choosy about what we do, and their outcomes are significantly better for a fraction of the cost. When you spend your own money, you become much more conscious about what you are buying…

All this sounds simple and straightforward to me, but it involves some very serious restructuring of our medical system. Somebody high up must realize things can’t continue the way they are and make a decision to change things, then ask different experts without conflicts of interests to help. I am standing by in case they ask…