This morning I read an op ed piece in my local newspaper by Cal Thomas talking about the British Health System. Now, like me, Cal comes down somewhere to the slightly right of Ghengis Khan politically, so it was no surprise that he mentioned 'death panels'. But the information he presented is reasonably well-researched and is consonant with what I am hearing from my colleagues in the UK. The British Health System is running out of money.
In his column, Cal quoted some reputable British newspapers describing horrible neglect and exceptionally high error rates in treatment of patients, especially elderly patients. He described physicians counseling older patients to consider how much medical care they really wanted at end of life. He described policy decisions that artificially elevated physician compensation over maintenance of adequate facilities or purchase and use of modern medical equipment.
At the end of the column (and throughout, actually) Cal kept raising the specter of this happening to the US.
Now it may surprise you to learn that I happen to believe that moving our healthcare system to a single payor may be the only way out of some of this mess. It is certainly a mystery to me how we ever thought that introducing a for-profit player into the middle of the healthcare system (i.e., the insurance industry) could ever result in excellent care and saving money. Insurance companies can only make their profit by taking money from patients and then denying them care. Their executives make 7-figure salaries that can only be funded by denying reimbursement for care to patients. While there can be no doubt that a government-funded single-payor system would have its bureaucracy, at least some of the money that currently supports the insurance industry stock prices might get directed back into advancement of the health system itself. My brother, a physician, has often commented to me that, as irritating as dealing with CMS may be, at least the rules are consistent and there are procedures for appeal if a decision seems arbitrary or unfair. By comparison, he often tells me, dealing with the private insurance providers on claim denial is a bad dream scripted by Kafka.
Back to the point...
There can be no doubt that the current healthcare model is generating unsustainable costs and has to change dramatically. Ultimately, in my opinion, dealing with the economic realities of healthcare with an aging population will require us to make some dramatic changes in what we provide and how, and I really struggle to see how privatization can be an effective solution to that problem.
Regardless of the outcome of that question, I believe that the time is rapidly approaching when the health system as a whole will be forced to ask hard questions about what it is getting for what it is paying, and to stop paying for services whose value is difficult to demonstrate. One of those items on the chopping block will, I believe, be our insistence that having highly paid professionals look at every tablet that leaves the pharmacy, or having highly paid professionals review and approve every order for Docusate is somehow adding value.
If we want to continue to make the salaries we make, we have to be doing things to earn those salaries, and sitting in a basement staring at computer screens seems unlikely to pass the test. We know that involvement in therapeutic decision-making is the only way we can exert control over drug use that makes any therapeutic or economic difference. We know that involvement at transitions of care is the only way we move the needle on the really big drivers of hospital cost: length of stay and readmission rate. We know that our legislated job security involves chaining us to tasks that have no potential to address the cost of care.
So it is urgent that we attack redifinition of our professional role so that we can become part of the solution of out-of-control health care costs. If we are not willing to reach for our potential as solutions to problems of cost of care, we will remain part of the problem. I, for one, would rather be part of the solution. Wouldn't you?
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