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


Blogger Mezamashii said...

Interesting read. As a United Statesian living in Canada, I have a whole new perspective on the real savagery of not providing universal health care.

12:57 PM  
Blogger Quiact said...

What follows are believed to be facts that are believed to exist regarding the present U.S. Health Care System. This may be why about 80 percent of U.S. citizens understandably want our health care system overhauled desperately due to the inadequate health care they receive and access:

The U.S. is ranked rather low related to life expectancy and infant mortality.

However, the U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases.

About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses.

Health Care costs are now well over 2 trillion dollars of our gross domestic product. This is three times the amount nearly 20 years ago- and 8 times the amount it was about 30 years ago.

Most is spent with medical institutions, as far as health expenditures are concerned.

About a third of that amount is nothing more than administrative toxic waste that does not involve the restoration of the health of others. This illustrates how absurd the U.S. Health Care System is presently.

Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.

We have around 50 million citizens without any health insurance, which may cause about 20 thousand deaths per year.

This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children, which alone covers about 7 million kids.

Our children.

Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage is largely due to unemployment.

With these Medicaid cuts, over a million people will lose their health care coverage and benefits to a damaging degree.

About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years.

About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported.

About half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well.

Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now.

The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system.
The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system.

Less than a third of all physicians are members of the AMA, according to others.

Our health care we offer citizens is the present system is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.

Health Care must be the priority immediately by the new administration and congress.

Challenges include the 700 billion dollars that have been pledged with the financial bailout that will occur, since the proposed health care plan of the next administration is projected to cost over a trillion dollars within the first year or so of the proposed plan to recalibrate health care for all of us in the U.S.

Likely, hundreds of billions of dollars that are speculated to be saved with a reform of the country’s health care system.

Health policy analysts should not be greatly concerned on the health care corporate shareholders who may be affected by this reform of our health care system that is desperately needed.

It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the public health.

This specialty makes possibly less than 100 thousand dollars annually in income, compared with other physician specialties, yet they are and have been the backbone of the U.S. health care system.

The American College of Physicians believes that a patient centered national health care workforce policy is needed to address these issues that would ideally restructure the payment policies that exist presently with primary care physicians.

Further vexing is that it is quite apparent that we have some greedy health care corporations that take advantage of our health care system.

Over a billion dollars was recovered for Medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations who deliberately ripped off taxpayers.

These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy, so it seems.

Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up this system as it exists today.

Perhaps the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens, it appears.

We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals, potentially, and health care for all completely.

It should and likely will be funded by a combination of payroll taxes and general tax revenue which is realistically possible.

Because the following seems to be in need of repair regarding the U.S. Health Care System:

Access- citizens do not have the right or ability to make use of this system as we should.

Efficiency- this system strives on creating much waste and expense as it possibly can.

Quality- the standard of excellence we deserve as citizens with our health care is missing in action.

Sustainability- We as citizens cannot continue to keep our health care system in as it is designed at this time- as it exists today.

Dan Abshear

7:00 PM  
Anonymous Psychology said...

thank you Dan. And thank dr.

1:27 AM  
Anonymous Anonymous said...

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9:48 PM  

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