Sunday, January 24, 2010

Lack of Healthcare Reform Means that the American Dream is Dead.

It appears that the American Dream is dead as the Democrats have essentially no chance in passing some sort of healthcare reform package. The stunning loss of the senate seat held by the late Ted Kennedy has now given the Republicans the ability to filibuster any significant healthcare legislation.

More disappointing is that Americans seem willing to accept the fact that they can live without healthcare. In a blog at US News and World Report titled 21 Things We're Learning to Live Without, besides abstaining from cable TV, a home phone, prepared foods, and lattes, healthcare was also on the list. Millions of Americans are apparently "simply hoping they don't get seriously ill or hurt." How can this happen is supposedly the wealthiest nation in the world? Too many Americans as a result are literally one illness or accident away from financial ruin as medical costs are the leading cause of personal bankruptcy.

While President Obama and the Democrats no doubt will try to salvage what they can from their hard work over the past year, they need to be thoughtful about their future proposals. Though the public doesn't like the thought of insurance companies turning away those with pre-existing conditions, the fact is that this practice exists because we don't mandate everyone have health insurance. As George Halvorson, CEO of Kaiser Permanente, noted to make healthcare affordable a double mandate must apply - everyone must sell (that is health insurers must sell coverage to everyone who desires it) and everyone must buy (all consumers must purchase). Otherwise, those who are healthy would not participate and instead would wait until they needed it. Those who are already ill will purchase health insurance. As a result, insurance companies would only receive payments from those who need medical care, which can't possibly cover costs of chemotherapies and hospital stays which are in the tens of thousands per treatment. Since the healthy don't subsidize the sick, insurance companies would simply go bankrupt.

With the President and his Democratic party concerned about a Republican resurgence, he has already refocused his attention on large institutions like banks and redirecting the populace anger there rather than working on meaningful change. He may try the same tactic on insurers in an effort to get some healthcare reform passed.

In doing so, he may simply ignore the truth of the double mandate and make insurers not only cover everyone but also have the federal government set the rates. President Obama knows of course that it would only be a matter of time that the government would take over healthcare as insurers would have no choice but to pull out in this financially unsustainable model. If a single payer system occurs be prepared for rationing of medical care. Imagine long waiting lists to see a specialist, getting surgery done, or wondering if a treatment might be approved. Certainly some of these problems occur already with private insurers, but envision if the healthcare system was run by the DMV. Is this actually better?

It's equally as unfortunate and more disappointing that the Republican party over the past year essentially only had one mission - derail any proposals from the Obama administration. Without healthcare reform to make insurance coverage more affordable to employers, families, and individuals, America will no longer be viewed as the vibrant superpower nation it has been over the past couple of decades but a country unable to provide the basic healthcare needs to its populace because its politicians were too paralyzed to do anything but score political points for the next election. Because of their failure to lead, it is increasingly clear that in the United States healthcare coverage isn't a right but a luxury.

If Americans and employers are constantly worried about saving money for a future expensive illnesses or medical problems, then when will they ever feel secure enough or freed enough to take risks, invest, and dream?

Friday, January 15, 2010

Book Review -- The Checklist Manifesto - Checklists and Team Communications Make Us Better

I’m a huge fan of Dr. Atul Gawande ever since meeting him at a patient safety conference in 2005, and then subsequently reading his books and following his New Yorker articles. Perhaps because I’ve been following his works closely or maybe because I’m a practicing doctor diligently making the healthcare system better is why I didn’t find his latest work the most compelling.

Dr. Gawande makes two points, checklists and clear communications among teams, are absolutely required to decrease errors and problems and increase the chances of absolutely the best outcome, whether in constructing buildings, flying airplanes, and performing surgery. We aren’t perfect. Systematic approaches make us better.

Only the last two chapters, “The Hero in the Age of Checklists” and “The Save”, which highlight the “Miracle on the Hudson” landing of US Airways flight 1549 by Captain Sullenberger and his crew and Dr. Gawande’s experience in the operating room of adverting a near catastrophe respectively, were the most gripping.

Ultimately, despite his points the irony will be that the healthcare system will not adopt these ideas, which are accepted as expectations in the aviation industry, because doctors still feel that we are somehow smarter or above checklists or teamwork. This failure to do what we are truly capable of is disheartening. As a result, individual patients will be the ones responsible in taking care of their health and asking questions. A good easy to read book or “checklist” in ensuring you get the right care every time is at Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System.

Although I wasn’t bowled over like his other works, nevertheless, I have my own checklist and that is to continue reading and learning from Dr. Gawande and many others who toil in making healthcare better and safer.

Sunday, January 10, 2010

Guaranteed Prediction - Pay More, Get Less - Your Future Health Insurance Plan

Even with healthcare reform, Americans will increasingly be burdened with high deductibles, more financial responsibility, and less satisfaction with their health insurance for the foreseeable future. Why? Because the healthcare system is unable to transform its services in a manner that other industries have done to improve quality and service while decreasing costs. The two biggest culprits are the mentality of healthcare providers and the fee for service reimbursement system.

Doctors and patients haven't altered the way they communicate over the past hundred years. Except for the invention of the telephone, an office visit is unchanged. A doctor and patient converse as the physician scribbles notes in a paper chart. Despite the innovations of cell phones, laptop computers, and other time saving devices, patients still get care through face to face contact even though banking, travel, and business collaboration can be done via the internet, webcams, and sharing of documentation. As Dr. Pauline Chen noted in a recent article, doctors are not willing to use technology to collaborate and to deliver medical care better, more quickly and efficiently. Mostly it is due to culture resistant to change. Partly it is due to lack of reimbursement. Both are unlikely to be addressed or fixed anytime soon.

Yet, patients come to doctors for our medical expertise and insight in order to stay well or get better. They don't care if it is done via the web or in person. If doctors think their problems are safe to handle via technology then they are for it. If doctors feel a particular condition must be handled in the office, then they are willing to do it. After all, aren't we the ones who can make that assessment? They trust us to make the right determination. We must be willing to challenge tradition and training in the face of a rapidly evolving world.

If this country is going to make healthcare more affordable and more accessible, then doctors need to collaborate better. Only doctors can stop the increasing march of medical expenses.

If we as a profession are unwilling to use technology to get the information and expertise to the point of care to get people better sooner, then our country has only two options left to make healthcare affordable. The first is the government to force pricing down as it is done in other countries. Based on the agenda of Medicare, the government is already squeezing costs by dictating pricing which may not be realistic. The second is to force patients to try and figure out which tests, procedures, doctors are best to help them. Research shows they don't want that responsibility and when they do have that burden they skip care. Nevertheless, employers are increasingly moving their employees to less comprehensive consumer driven health plans (CDHP) and high deductible health plans (HDHP) to save money.

It's doctors who aren't willing to do virtual visits. The public is ready and waiting. If we as a profession won't consider using the same technology we use to communicate with family and friends as well as use these very same tools to provide "second opinions" to our loved ones who value our medical expertise to our patients, then how can we say that we are committed to making healthcare accessible and affordable to all Americans?

While there is a small group of enthusiastic entrepreneurial doctors and leading edge healthcare organizations trying to move American medicine into the 21st century, the healthcare system really needs Steve Jobs and Apple to transform healthcare. As it currently exists, the majority of doctors are either unwilling or unable to make the change.

Sunday, January 3, 2010

Hate English. Became a Doctor. My New Year's Resolution to Blog and Fix Healthcare.

I've always wanted to be a doctor.

Never a writer.

With a new year and a new decade, I am determined to become a better writer not because of some childhood dream or expectation from others, but because of a near mishap that occurred at the beginning of 2000. A simple phone call changed the destiny of my brother from having a good outcome to having a great outcome. A simple phone call may have been the difference between you are cancer free to I'm sorry to tell you its come back.

It was a medical error that was avoided only because I was a doctor who was engaged to an oncologist and because my brother simply called me the night before his surgery. Based on his diagnosis, his surgeon should have referred him to an orthopedic oncologist, a musculoskeletal cancer surgeon, to perform curative surgery. Only two exist in the entire state of Connecticut. Instead, the surgeon opted to do the surgery himself even though he admitted he didn't know what the diagnosis meant.

A simple phone call the night before made the difference between being told that unfortunately your cancer came back to you are cancer free.

What if you had the knowledge to make a difference to save lives? What if you could see the problems that others don't or refuse to see? Would you feel compelled to intervene? I write and communicate this information because our healthcare system, the doctors and hospitals, that we or our families rely on at some point in our lives is not as good as it can and should be. Each of you have your stories. Healthcare reform will not fix the problem.

It was my brother's phone call and many subsequent episodes with other relatives that made me glad I became a doctor not because I could help them get better sooner, but help stop bad things from happening to them as a result of a less than perfect medical care.

Despite my knowledge, I wish I could say I stopped each and every bad outcome. I didn't. I couldn't. Every missed opportunity to intervene and make things better bothers me today. I am a better doctor today than I was a decade ago and will undoubtedly be a more skilled physician a decade from now.

As everyone this new year focuses on typical goals of becoming healthier by exercising, losing weight, and ridding themselves of vices like smoking and excessive drinking, I have a completely different lifelong mission: to educate individuals on how to get the best medical care by giving them insider tips only a doctor would know.

As a doctor I've taken a pledge to do no harm and help those who suffer. To do that I need to be a better writer.


Related Posts with Thumbnails