Thursday, November 27, 2008

“If I were President Obama’s Health Care Czar- Here is what I would tell him”

Health care is complex Mr. President- No country on the planet has completely figured it out. But clearly there is something terribly wrong with the Unites States- the wealthiest nation on the planet- having 47 million of its citizens uninsured (>15%), with many millions more underinsured, not having the peace of mind that when they are sick they can access some level of health care. This is not only wrong, Mr. President –it is immoral- an immorality, Mr. President, that betrays the nobility of both the great profession of Medicine and the greatness of our nation.

Yet conversely, Mr. President in my opinion we in organized medicine and those industries that profiteer from it (most notably multinational pharmaceutical companies, diagnostic equipment companies and medical instrumentation companies) are in part to blame for promoting the premise that high technology medicine solves all human problems. We have medicalized all sorts of America’s social problems like joblessness and poverty for which there really is no justifiable medical intervention.

We must, as a profession, convince ourselves and our patients that in medicine “more is not always better”. We must focus, Mr. President, on diagnostic and therapeutic medical interventions that rigorously stand up to the necessary tests of proven efficacy (does it work?) and, more importantly, proven safety (does it harm?). Also, we in the medical profession- recognizing the truly miraculous technologies we have achieved- need a strong dose of humility now to recognize that we cannot cure everything. Certainly “aging and death are not curable medical conditions” Caring must achieve parity along with curing. We are not in fierce battle with disease. We are instead, first and foremost, in a caring profession- a profession that recognizes that just simply “being there” for the patient and their family is perhaps our most fundamental obligation. Mr. President- that is actually the historical root of the phrase “attending physician” which is still a term in common use today.

Many have said, including Dr Elias Zerhouni – immediate past head of our prestigious US National Institute of Health (NIH)- that a high-tech-high-cost treatment driven “disease care system” is just not economically sustainable.

Now I fully realize Mr. President that transforming a $2 trillion dollar plus disease care industry in this nation will be painful for many including possible economic dislocations for many employed in this industry. But we must transform our disease care industry into one that emphasizes and economically incentivizes and rewards both individual (health behaviors) and more importantly institutional (public health) prevention. We must retrain our disease care workers into genuine health care and prevention workers. We must transform high-tech-high-cost, often dangerous, hospitals into great institutions of healing again. The money save by engaging through this necessary transformation will free up necessary funds for those who really do need the best technology that contemporary bio-medicine can offer. Mr. President – we must engage in this necessary transformation incrementally and with great compassion since it is a change of monumental proportions.

Mr. President. I realize that my proposal to you is bold. But our times call for boldness perhaps like never before in our young nation’s history. Mr. President-Tinkering at the edges of a conceptually and fundamentally broken US health care system is not enough.

As your trusted advisor I believe that ultimately we need the kind of dramatic and bold change in health care as we envision and propose to address in dealing with our global environmental crises. Nothing less, Mr. President, will carry the day.

Be Well Mr.President

Dr. Richard Lippin
Southampton, Pa

*Reprinted with permission of Assad Meymandi MD.PhD., Founding Editor-in-Chief of the Wake County Physicians Magazine .Vol. 14, No. 1, January 2009