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Will they just tinker around the edges?


Fri, Jan 9th, 2009
Posted in Commentary

The editor has asked me to focus my commentaries on healthcare reform efforts and similar subjects. The subject should allow me to be as curmudgeonly as I want to be. I don't agree with any of the politicians and very few of the people I have discussed the current state of our non-system of healthcare.

What is the current state of the United States healthcare? The newest figures show we spend over $7000 per person on healthcare per year. This is the highest of any country and 16% of our gross domestic product. We lead the world in healthcare expenditures. That's the only healthcare statistic in which we hold the lead.

We are way down the list of developed nations in infant deaths, life expectancy at birth, and a host of other measures. Apologists for the system continue to point to differences in ethnic makeups of countries, differences in statistic collections, and other nit picking excuses for our dismal showing.

One statistic they can't sweep under the rug is amenable mortality rates. That is the rate of deaths per 100,000 people who should be saved by appropriate medical care. In the late 90's we were 15th out of 19 in this measure according to the World Health Organization. By 2003 we had fallen back to last place.

The gist of the matter is, we are paying the most and getting the least. Fortunately, for those reading this in Fillmore county, we reside in a part of the contiguous five state area that spends the least and I suspect get the most for our buck. We are one nation and what affects those in New Orleans, Boston, Phoenix, and LA effects us all. At least if you believe in community, society, and civic responsibility, it does.

Many do and many are effected by out of control costs because all of the political candidates proposed faint hearted healthcare reform. The economic meltdown and the last administrations deficit spending have constrained even those who would give lip service to meaningful reforms.

Obama has the wheel of the ship of state now and his healthcare pronouncements during and after the election leaves me disappointed. He continues to believe tying health insurance to employment is all right. There is nothing in his plans to adequately control costs. There is minimal effort to increase effectiveness of care and/or discourage examination and treatment options that are not proven to be effective. So far I have not heard or seen anything about improving access to care for all. I have not seen or heard anything about improving equity and a common level of necessary basic care for all.

It is true; he made only vague promises about change. His appointment of Tom Daschle as head of Health and Human Services is comforting. Daschle has been absolutely silent since being named. Maybe this means he is working on legislation or legislators and is a good sign, or not. We can only hope Daschle has a residue of good relationships and has more ambitious plans than we have seen as yet.

Meaningful healthcare changes will entail more than who is paying the bills or how they get paid.

All other developed industrialized nations, with the exception of Switzerland, pay half per person per year compared to the U.S. The Swiss pay about 65% of our costs per year. All have much better health performance statistics.

Meaningful reform, I believe will have to include cost controls. Not only on insurance companies, on all healthcare industries and participants similar to the Medicare systems cost controls. All senior citizens on Medicare can tell you about these controls.

Changes must be made in the patent structure for medications.

In short it all costs too much and we can no longer be the only country that allows "what the market will bear" to determine the cost.

Reasonable rationing of care will be necessary. Medicare will no longer pay hospitals and doctors for "never should happen" medical mistakes. Things like operating on the wrong leg will require hospitals and doctors to foot that bill. Cosmetic surgeries for vanity, liposuction, and other such will have to be paid for privately.

An independent healthcare board has been proposed to monitor all government involvement in healthcare with long staggered terms such as nine years to reduce political interference. This board would also over see studies to determine if treatments and exams are clinically effective and their appropriate use.

Effective efforts to promote innovation and continuous improvement in all areas should be the charter of the health board as well.

Effective efforts to increase access to high quality care in inner cities and rural areas are desperately needed.

In short we need cost controls, clinical over sight of treatments and examinations outside the political arena, improved access for all Americans, and continuous vigilance and innovation in all parts of the system.

Dr. Robert Sauer of Preston is a retired family physician. He writes regularly on health care and can be reached at r.sauer@mchsi.com

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