This year health care reform has become one of the issues in the race for the White House. While the candidates tout their own plans while criticizing their opponents, the real question is, what issues are vitally important? As doctors, we don't lose sight of the most critical elements, the ABCs, airway, breathing, and circulation, in an emergency. With healthcare reform, focusing on the essentials can clarify what would otherwise be a confusing situation. Improving our healthcare system will require the following issues be recognized and addressed.
We are not getting the most value out of our healthcare dollars. Repeatedly we spend the most per capita than any other industrialized country in the world and have the worst outcomes. A recent 2007 report by the National Committee for Quality Assurance found that 75,000 insured Americans died prematurely because they did not get level of care observed in the top performing health plans. Had they been enrolled, they would be alive today. If we continue to fund a system that rewards mediocrity we will have failed. We should reward those hospitals, doctor groups, and insurers, that already consistently deliver the right care at the right time and support others to improve quickly.
Our healthcare system's financial incentives need to change. The number of primary care physicians is inadequate to meet future demand. Current and future retirees are living longer than a generation ago and also developing more chronic illnesses. At the same time, fewer graduates wish to pursue this specialty due to high medical school loans and lower reimbursement compared to specialists. Doctors get paid to perform procedures and not to think or provide counsel which disadvantages the primary care specialties. In 2003, of those resident physicians completing a three-year residency program only 27 percent planned to be internists, down sharply from 54 percent in 1998. Studies have shown that countries, healthcare organizations, and individuals who mainly rely on primary care physicians do better with less expense.
Everyone must be required to have healthcare insurance. The fundamental truth about insurance is that everyone needs to take on the responsibility for the minority who are at risk for an adverse outcome. If health insurance was not mandatory, individuals would simply jump in when expensive medical care was needed (i.e. pregnancy, cancer) and leave when the situation improved. Healthcare costs would increase exponentially. Preventing this adverse selection will mean everyone must pay into the system.
Healthcare isn't cheap. In fact, many Americans have discovered that health costs are the leading cause of personal bankruptcy. Yet odds are very good that you will. The American Cancer Society predicts that a man has a 1 in 2 chance and a woman a 1 in 3 chance of developing a cancer sometime during his or her lifetime. This calculation excludes patients with the more common forms of skin cancer like basal cell cancer and squamous cell cancer. Remember cancer is America's second leading cause of death. Expect to need doctors and hospitals sometime in the future.
Finally, don't let the government run healthcare. A single payer solution would put the healthcare delivery system at the mercy of political whims and the budget process. Would you like to be hospitalized only to discover that the federal budget and the funds used to provide your care were being debated or traded for other programs the President and Congress felt to be more important for their constituents and agenda? Instead, the government should provide incentives to those whom the market would not normally enroll, guarantee insurability, set up a large insurance pool or trust to benefit from the economies of scale, and assist those who need help and who don't currently qualify for the Medicare and Medicaid programs.
This checklist of important issues, while far from comprehensive, distills the debate into key elements that are vital for healthcare reform. To be successful we will need those who provide care to do deliver care more consistently and regularly to that of recommended guidelines, a deliberate rebuilding of our insufficient primary care workforce, require an individual mandate for all Americans, and elect government leaders who support the insured marketplace to that provides coverage for all. We know what to do. We must act quickly. Without these important and essential interventions, we are simply allowing our critically ill healthcare system to slowly wither away on life support.