The need for healthcare reform becomes ever more obvious.
First, the economic downturn has, unsurprisingly, forced some family members to choose between caring for an ill family member and generating sufficient income to pay for housing, buy food, and cover other basic expenses. (John Leland, “Downturn Puts a Chokehold on Those Caring for Family Members,” New York Times, June 7, 2009) That choice is unfortunate for all of us, especially taxpayers and people who pay for private health insurance. Care provided by a family member tends to produce better outcomes for lower costs. When forced to rely on insurance benefits or publicly funded help (Medicare, Medicaid, etc.), other premium payers or taxpayers bear increased costs that yield worse outcomes.
Second, research shows that doctors who spend more time with patients provide better care to those patients. This leads to healthier patients at less cost. (Julie Weed, “If All Doctors Had More Time to Listen,”
Quantity, not quality, has become one of the healthcare system’s key metrics. Quantity, unlike quality, is readily and objectively measurable. The best measures of quality healthcare are maintaining the maximum possible level of health while recovering as fully and quickly as possible from any disease, injury, or disability. A few components of that definition permit direct or indirect measurement, e.g., by comparing average times for a simple tibia break to heal one can approximate a norm, while recognizing that other factors, some known such as diabetes and others unknown, will cause individuals to heal at divergent rates.
From a policy perspective, unlimited healthcare is unaffordable for most people, regardless of whether the individual or the government funds that care. Thus, providing quality healthcare requires identifying those components of care that contribute the most to improved health. Allowing physicians to spend more time with patients clearly meets that test.
Applying market economics to healthcare reform in light of the above suggests that increasing the number of doctors should allow physicians to spend more time with each patient. Having more doctors might also lead doctors to compete with one another on the basis of quality and price. Competition could beneficially reduce physician incomes, reducing the number of persons enticed into the medical professions through the lure of six and seven figure incomes. Competition with informed consumers could accelerate a shift toward selecting treatment and practitioners based on outcomes rather than other criteria. Careful regulation could avoid undesirable competition’s consequences.
Perhaps the most egregious proof of the physician shortage is the immorally long hours that interns and residents must routinely work (often eighty or one hundred hours per week). Mandating those hours neither improves training nor the quality of patient care. Indeed, just the opposite happens: training and patient care both suffer.
The choke point for producing sufficient numbers of doctors is the limited number of slots in medical schools. Medical schools are expensive operations. However, lower salaries paid to medical school faculties, finding economies of scale, and seeking less expensive pedagogical modalities all offer options for cost reductions.
3 comments:
Our healthcare system is broken but giving the standard answer of providing more assets with less pay is not going to solve this problem. I agree high six or seven figure pay is out of line but who gets it. Probably the rich are their patients.
Until there is some tort reform, doctors have to pay exorbitant fees to get insurance. I don't believe we should have a system where a person puts their life in someone's hands and expects that they can perform miracles each and every time they do a procedure or prescribe a drug. If the person is not satisfied with the results, he sues expecting a big reward.
To me the patient should be made well if possible, but receive no large payout, especially when the lawyer gets most of the settlement.
Every drug we take and every medical procedure has risks. The bad side effects are attributed, hopefully, to others but the effects can put us in the number that did not work.
With almost everything we use has a class action suit against it and someone has to pay.
We need to look at the causes of many of our medical issues and try to prevent them from happening. We are so concerned about germs that our immune systems are very weak and provides drug companies with more reason to provide another drug. Our lifestyles make us wrecks and we demand to be made whole and youthful.
So prevention should take a higher priority than providing possible cures. It is almost getting to be a requirement that people should have to sign a release form before getting treatment or to use items that will eventually harm them. Cigarettes, obesity and meth are examples.
There has to be a limit to the amount of treatment people receive. I know people who go to a doctor on a regular schedule as a part of their weekly or biweekly event. Doctors also want repeat customers to make appointments even if there should not be follow ups.
I doubt if we will get many qualified doctors with lower pay and higher risk. More time with the doctor will help but how long is right. Do you want to be the one waiting to see the doctor?
I have one possible solution. We need to do like the Russians. Instead of having people go through years of medical school, internship, and residency before deciding on their specialty, we need to teach people on specific areas of the body.
As an example, to do cataract surgery , a doctor does not need to know orthopedics. They would become technicians and receive all the training required to work on the area.
Once again we have the ability to keep people alive but how much do we pay to do it and what quality of life do they receive. Please spend some time, like a full day or more at an average nursing home and tell me you want to live in one. No, we can't have the money or responsible personnel to make every home just like we want it to be.
A question for you and any other person. How do you want to die? Ask a doctor and they all say in their sleep but most people don't have that option. I look forward to a massive heart attack in my sleep. This is not the way we look at our medical system and our hopes and technology.
Ted, we share much common ground.
Tort reform is an essential element of effective healthcare reform, reducing costs by limiting liability, limiting payouts, and eliminating expensive defensive medicine.
Similarly, preventive rather than curative medicine reduces costs while leading to better health. People and corporations with substantive financial stakes in the current, dysfunctional hodgepodge of the U.S. healthcare voice the loudest protests against any shift toward prevention, often arguing that prevention intrudes on free choice. Those protests ignore the costs that unhealthy choices such as smoking, overeating, and inadequate exercise impose on everyone.
Healthcare rationing should be a function of probable outcomes, not ability to pay or the noise level of the ill and their supporters.
Doctors in the U.S. earn significantly more that their counterparts in other developed nations, even when those incomes are adjusted for differences in the cost of living. Having more doctors would allow doctors to spend more time per patient without incurring long waits; reducing physician income would keep the total cost constant while improving the quality of care. College students queue to take pre-med courses. The physician shortage results from limited medical school enrollment rather than lack of qualified, potential med students.
Perhaps better than training people in only specific diseases/body components, is to rely on a more multi-tiered delivery system in which people with less training provide routine care or, when appropriate, referral to an MD or specialist. Some progress in this direction is evident, as the number of nurse practitioners and physician assistants is increasing. The military healthcare system adopted this approach decades ago and proves that it works. In any case, creative solutions are possible, solutions that special interest groups with a vested interest in preserving the status quo adamantly oppose.
As an example, to do cataract surgery , a doctor does not need to know orthopedics. They would become technicians and receive all the training required to work on the area.
Like you, I think a quick death best. The one caveat I would add, from decades of helping people deal with grief, is that a quick death often leaves loved ones less prepared to cope with one’s absence than does a slower death.
Tiered training is a good start as the college students could do the training while in college and upon graduation be able to join the workforce. I was surprised to see my nephew graduate from NCSU and upon graduation, he had to study to take the required tests to be certified in financial planning. His last semester should have included taking all the tests needed to do the job instead of courses that had no impact on his future occupation.
Another area we need to work through is to understand that doctors are not miracle workers and ALL medications have side effects and each person is different.
Personally, I would limit how many medications people take as no one knows how drugs interact with each person. Too many people have followed doctor's advice and ruined their lives while believing they are getting the best care available.
Here is an article t explain thing we don't want to believe.
http://tabacco.blog-city.com/iatrogenic_deaths_americas_dark_secret__leading_cause_of_dea_1.htm
We have to go to quality care and not quantity, believing the more tests and procedures will make you well.
An article several months ago stated that religious people rely more on science and doctors in the last few weeks of their lives than those without so much belief.
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