An interesting article called "Harry, Louise and Barack" in today's New York Times by Paul Krugman reminds Americans of the recent history of national health care management. This area promises to be one of the central contributions of the Obama administration to social policy and national living standards. Health care reform would also be an overall benefit to the economy.
Here's why: there is a toll cost down the road to ignoring the health of all. Health, like safety, is what protects society's weakest and sickest. Health care is an issue that is ignored until it becomes impossible to ignore. That's the nature of the beast.
In addition, health care costs non-profit as well as governmental organizations relied upon by the entire population increasingly significant overhead to pay health care costs. Profitable organizations aren't exempt from paying health care costs, either. These costs have risen dramatically in recent years, along with almost everything else. Health care costs continue to increase into the retirement years of employees.
Powerful special interests blocked long-term health care coordination and planning in 1993. Krugman mentions that "Republicans, after all, still denounce research into which medical procedures are effective and which are not as a dastardly plot to deprive Americans of their freedom to choose." We're talking about choices, but we're also talking about the sick, who sometimes have no choice but would do anything to improve their health.
It is irresponsible of physicians to expect patients to be able to choose procedures. Physicians have a responsibility to guide patients. Fear of being sued pushes many doctors to over-prescribe drugs and tests. This forces patients to choose prescriptions and services and thus, self-prescribe. Patient outcomes are less predictable if doctors can't be trusted to direct health care. Avoiding litigation becomes more important than optimal patient care in the current health care environment.
Peter Orszag, Director of the Office of Management and Budget, has said that "America spends far too much on some types of health care with little or no medical benefit, even as it spends too little on other types of care, like prevention and treatment of chronic conditions. Putting these together, he concluded that “substantial opportunities exist to reduce costs without harming health over all.”
These issues must be addressed by medical experts. Computerizing medical records will be the least of the problems for the staff. It's the doctors themselves whose attitudes must change and who must be persuaded to reform health care. Doctors should agree on medical procedures. They need to take a leadership role or else insurance companies or the government will increase in power. Presenting choices to a sick patient isn't the same as asking a well person to choose from hundreds of wallpapers. Patients deserve, quite appropriately, to be well-guided by doctors. They prefer to have a personal relationship with a doctor of their choice with the power and authority to treat them.
According to Krugman, a Nobel prize-winning economist, the Medicare Modernization Act of 2003 "both prevented Medicare from bargaining over drug prices and locked in huge overpayments to private insurers." If true, "heavy-handed corruption" is the descriptive phrase I would give to that pyrrhic victory of the Pharmaceutical Research and Manufacturers of America, PhRMA.
Quality is an indefinable good that varies with each patient, yet cost control and efficiency of medical care are immediate benefits to all. It is the responsibility of the healthy to care for the sick, but it is not necessarily the responsibility of the sick (and close relatives) to bear all possible costs. That mentality to me is unnecessary, misguided and exploitable.
Finally, let's look at the supposed trump card of "superior research." Not all biotechnological research is sourced and performed here in the United States. That is nationalistic propaganda advanced to gain American federal funding from tax dollars. Perhaps there is widespread fear by medical professionals that other countries are gaining health advantages from investments made by big American pharmaceutical companies. Most scientifically advanced nations already perform pharmaceutical research experiments. The field of biotechnology is replete with foreign companies and foreign university researchers sharing results of their experiments for American pharmaceutical companies, or others, to capitalize on.
Drug and medical test costs should be shared, with tax payer money deployed more efficiently. Litigation awards shouldn't be outrageous, especially to lawyers, and communication should be increased with the use of technological tools.
It will be up to doctors and medical insurance and pharmaceutical companies to get their acts together. They will have to communicate research results, cooperate, organize and focus on patient care in their disciplines, and co-ordinate that care to control costs. If they don't do so quickly, as they haven't voluntarily in the past, say, twenty years, reform will have to be imposed on them.
And that's all right, because popularizing doesn't always destroy, it can build. Like education and car-buying, health is collective in scope and individual in experience. Patient-based care rather than "greed-based" care is not just an ideal, it's a necessity for over 50 million Americans currently uninsured. Let's hope medical insurance quickly becomes affordable to those most in need. The President may have been accused of doing "too much" but time is of the essence as far as health care is concerned. Coordination of this particular medical emergency is key to the future success of America.