Health Care in America

DocBrain just took the www.vajoe.com candidate test. Rudy is his man. And yet, Rudy misses the boat on health care. As does every other candidate. I will say that he misses it somewhat less than others, but still misses the mark.

The key issues at ground level.

If you are part of the government, you are part of the problem. Some examples.

• The FDA determines not only safety, but applicability. This slows down the approval process and limits dissemination of information about unlabelled but effective uses of health care products. Doctors are expert at reviewing the medical literature and claims of effectiveness. We went to school for that. That is our job.
• Doctors, hospital administrators and nurses are patients, too. We know where the problems are. If we don't know how to fix them, we will ask. If regulations were the answer, no one in America would die. We are so busy with stupid, pointless, and unflexible regulations that we don't have time to deal with sick patients.
• You are setting the standard for reimbursement through Medicare, and that standard is inappropriately low for what is required. Reimbursement is tied to documentation, not to provision of quality service. The documentation requirement does not reflect quality, but does allow draconian enforcement of "fraud" or where the doctor bills for spending more time with the patient than with the chart. Drop the chart minutiae reviews and penalties and allow us to do our jobs. Better yet, get out of the health care marketplace.
• Reform malpractice laws. The adversarial system works well in many circumstances, but not in health care. See other posts in this blog, but the short answer is that people stick to positions when they are threatened; they do not solve problems. Most patients want problems solved. A few think they want obscene rewards, but find that these do not produce happiness or satisfaction, except for the malpractice attorneys.

If you are part of managed care, you are part of the problem.

• When you graduate medical school, take the history eye to eye with the patient, examine the patient, review the tests and other reports, become current with the literature, then and only then, can you prescribe testing or treatment for a patient. And you are responsible for what you find out and what you have missed. Managed care tries to control interactions, testing and treatment without the prerequisite responsibility, hiding under the curtain of "we don't say what to do, only what we will pay for".
• If managed care has a fiduciary duty to its subscribers. Managed care organizations have no business contributing to charity, advertising in sports stadiums, acquiring large real estate holdings, or stockpiling billions for acquisitions or other non-delivery issues. It is not their money. It is the subscriber's money. There needs to be a code of ethics for managed care.
• Just because you know the bureaucratic line doesn't mean you know what is right. Procedures, treatments and referrals are denied based on outdated and simplified, but codable software. Again, just pay for what the doctor and the patient agree are needed. We are not ripping you off. Honest.

If you are a malpractice attorney, you might be part of the problem.

• A mistake is a mistake. A bad outcome is a bad outcome. The twain do not always meet. Delivering health care is like playing roulette. Occasionally you land on 00. No one is to blame. Don't penalize physicians for their personality. Your duty as a malpractice attorney is to help us fix the system by helping those who are harmed by a mistake, not to use weasel techniques to convince a jury that those injured by an act of God or a random occurrence deserve retribution from the providers. If you have a valid case, I would hope that the physician/hospital would want to settle and move on. That has been my experience and observation. If there is strong resistance, you probably have a bad case.
• You are helping individual patients. You are not improving health care. You probably are worsening health care and are certainly increasing costs for everyone. Can you deal with that?

If you are part of the problem, you will try to obfuscate the issue and blame doctors, hospitals, pharma, the uninsured, whatever. I am on to you. Many people are.

I just wish that the politicians would open their eyes.