Thursday, November 20, 2008

Perhaps a little light from a long tunnel...

What a difference an election makes - it's all about dumping far-right, far-left ideologies and really address the issues that affects everybody today and now insurance companies are wanting to play ball as along as everyone is covered!

Speaking of which, this is an excellent summary on the plight of primary care. Again, more of the same but highlights the struggles and obstacles to improving our health care system. As I read this, I was reminded of my experience as a 1st year family practice resident at Hennepin County Medical Center in Minneapolis, Minnesota nearly 8 years ago and one of my esteemed preceptors, the now retired Dr. Harley Racer, talked to me about how I only get 15-20 minutes with a patient after I had spent nearly an hour talking to a patient who had diabetes, hypertension, liver disease, and tobacco use and managing the myriad of issues (sound familiar to other family physicians?); I certainly understood his position that we were working within a confines of a messed up system, but he encouraged me not to give up hope; that we went into medicine for noble, selfless reasons. I saw in his aged eyes, knowing that he participated in being a general physician since the 1940's, that he'd seen a world that has changed before him. I never forgot that lesson and I carry it with me to this day. Perhaps, with perseverence, there can be a light at the end of the tunnel.

Wednesday, November 19, 2008


As I scan through the various medical blogs since the election, I see an emerging civil war between specialists and generalists erupting from various proposals from policymakers, such as Senator Max Baucus from Montana. In order to fix the U.S. health care system, addressing the plight of primary care physicians is absolutely essential. What does that mean? For some, it's "spreading the wealth" in regards to income distributions between specialists and generalists and that strikes fear into the hearts of specialists who have depended on the decades long payment system that favors procedures versus investment in prevention. There's also stuff of sorts that primary care physicians don't work hard enough and we have to see more to make ends meet. Heard that before. When we cut through the spin and fear-mongering; the essential question is this:

Are we as a society going to understand and redefine what it means to have a health care system that actually values health? Or are we as a society going to believe that the direction we have been going is the best that we can do? Now, come up with your answer....

I've also read other weblogs where physicians are absolutely horrified by the prospect of a single payer system that the current examples of Medicare and Medicaid are going to spell doom to the health care system as a whole. Yes, if Medicare and Medicaid were the only payers in this nation and working exactly the way it is right now, I would be awfully afraid of what would happen to our healthcare system. However, in response to that concern, I propose the following.

Call me an optimist, but there have been numerous periods in American history that when there is a calling and we have an inspirational leader, we can acheive great things together. Franklin Delano Roosevelt and the New Deal and the defeat of Nazi Germany and Japan; John Fitzgerald Kennedy and taking the man to the moon; Lyndon B. Johnson and the Great Society. If we can do that then, how come we cannot acheive a perfected health care system for all, starting now? The great start, which I'm glad that President-elect Barack Obama stated in the debates, is that health care is a right for all Americans. And I think most people will agree on this now. Not too long ago, that was not the case.

Lately, over the past 30 years or so, we have not had the gumption or clarity to take us where we need to go...and just like someone who has not yet understood the importance of change because there is lack of awareness in the problem (alcoholics, for example), perhaps the most of us in the U.S. were led to believe that our system is the greatest and infallable in all the world. We've all heard in some way, shape, or form that our health care system is the "greatest in the world", and it's all because it's not "Socialized" medicine. Peel away the layers and over time, the symptoms of the illness we call the dysfunctional health care system shows through. The growing numbers of the uninsured. The hurting businesses trying to pay for health care for their workers and losing competiveness around the world. Our fallen economy. Mounting health care bills for families. Overflowing, overburnded, burnt-out emergency rooms, urgent care clinics, and primary care clinics. Rural clincs struggling to stay afloat. Medical students, wanting to do primary care, but with financial burdens, deciding that the wise thing to do is to be a specialist. The cycle feeds itself and leaving destruction, anger, frustration, and fear in its wake. And the results show. The "fundamentals" of our current system are misguided, bordering on unethical (in my opinion), overly complex, and highly counterproductive. These fundamentals are then fed and supported by fear and greed.

Right now we are peering down the chasm of this so-called illness and wondering, should we just continue to ignore it and pretend that it will just go away, or shall we face it and confront it?

Once we make the awareness, which believe we are at this junction (it's long over due, in my opinion), we have the capacity to start change and work together with a committed goal. Going back to my optimism statement, I believe that we have so much untapped potential - all of the current health care workers, those who work in our clinics, hospital, and yes, even the insurance companies, that can be channeled into this endeavor to look at our system with fresh eyes and renewing a commitment to care and quality for all Americans; look again and what it means to have "market-driven" medicine and focus again on what is good for all rather than just for a priveledged few. This is the stuff that's happening in the grassroots right now, in Oregon.

Imagine if this can spread to the rest of the nation. I can see, from our nation's history (I'm kinda a history buff), that we can have great ideas and great people - coming from true intentions that exemplifies the common good. Just look at our attempts to bring a man to the moon. We poured our efforts into education in math and science with true competition, not out of greed, but for the goal of space travel.

What I see is that we can have a system of health care that balances the independence of physicians and patients, taking the middlemen of payment out and consolidating it to the largest insurance risk pool (national insurance) and where the responsibility of the management of the risk pool is dictated by the mandate of the people (taxpayers and those who vote)...and where doctors no longer have to be torn between the triangulation and really focus on delivering quality health care (this is where my passion is!). What does that describe?

Single-payer health care.

Ahh, but do we have evidence that this works?

Yes, we do...think of all other industrialized nations in this world and everyone else has shown that health outcomes have generally improved when there is a unified, single-payer health care system (there's different variations, but all variations on the same theme, where everyone is covered). We may argue that the United States can choose to be different (like who else in this world use the English or Imperial system for measurements and temperature rather than metric?!?!...but that's another diatribe for me), but the cost of choosing to be different far outweights the benefit of making a smarter choice.

So, this is what I would say about the whole topic. Learn from others and learn from history. Use the links above to be the starting point and guiding light to get to the answer. Don't just take it from me, but maybe we'll all end up agreeing. Now that'd be nice, wouldn't it?

Tuesday, November 18, 2008

Hope, maybe?

I'm so glad the election went the way it did. Now, the hard work begins. Recognition of the problem is step one and that begins with more mainstream media attention being paid to the plight of the primary care physicians. The reason? Much that has been said here in this blog. Hopefully, the solution to the health care crisis will involve the recognition of the work of primary care physicians - prevention, education, and bringing back the meaning of health in "health care".