No one is going to flame you for being "frusterated", amyl (too cute
). The point is that we, as a group of physicians, are not empowered by our government to be part of healthcare change. We are regarded as imminently self-interested, and felt to hold way too much power over our patients already. So, we are prevented from doing such things as forming unions and collectively bargaining.
What we need to do
immediately to fix the healthcare crises in this country is fairly simple, painful but simple:
1) We need to do away with the current
EMTALA regulations as they are currently envisioned. This was a (relatively) good idea at its inception that has been subsequently abused. It essentially handcuffs hospital administrators into treating patients who present to ERs regardless as to whether or not they are actually having an emergency. They (generally) don't pay. They (generally) don't follow-up in their treatment. They (generally) tend to present back to the emergency room for additional care. The system currently encourages this type of behavior in an select population of patients for whom healthcare is seen as a "last resort" option from a culmination of their bad personal behaviors. We have to put an end to this free ride.
2) Mandatory healthcare coverage (i.e. insurance) or no service rule. Patients should be required to pay a "retainer" up front before services are rendered. They should be required to carry
independent healthcare insurance (not provided by an employer) and the government should incentivise people, with tax-breaks (etc.), to carry such insurance. Like car insurance, people should individually purchase this coverage. It should not be provided as a perk by an employer. The main advantages to such a change are two-fold. First, it will breed competition among insurance providers to provide the best possible coverage at the lowest dollar amount while stratifying risk at the individual level. Second, it will provide portability to the insured. When a patient leaves a job or their employer decides to shop for a new healthplan to cut costs, they won't have to pick-up a new plan with "pre-existing diseases" exemptions as well as start the painful shopping for new doctors and clinics to get their care. This would be a more patient-friendly system and provide better continuity of care.
3) Mandatory health screening. In order to keep your policy, you would have to see a primary care provider at least once a year for a health check-up. This is already a feature of most plans, but people rarely take advantage of it. If we're going to be serious about preventive medicine, such a policy has to have some teeth.
4) Universal catastrophic coverage in lieu of medicare/medicaid. In order to keep costs down, there should be a system that mandates government payment
only for catastrophic coverage - and everyone would get it. This would serve to supplement your private policy, not replace it, and would apply to everyone. You would still be responsible for a portion of whatever bill was generated by the hospital up to a ceiling amount, but you would get coverage for major unexpected and unplanned medical expense.
5) Governmental oversite of prescription cost. The cost of pharmaceuticals would be regulated at the national level, much like in Canada, and the overall price of a medication would be fixed at a national level. There would be no negotiating with individual health plans or large retail chains. This would also serve to bring back the mom-and-pop pharmacies and a more personal relationship with individual pharmacists that we used to enjoy before the WalMarts and KMarts and Targets started bullying the system. This would also ensure a uniform and fair price for everyone. The downside of this, though, is that it would tend to engender a "national formulary" type of system, and some physician choice of pharmaceutical would be limited. A small price to pay, in my estimation.
6) Capitation of monetary reward allowed to individuals and plaintiff's attorneys from malpractice lawsuits. Currently, in some instances plaintiff's attorneys can get 33-40% of the jury reward from a verdict in a case. This is the "bonanza" and "spaghetti" theory of our jurisprudence system combined. Plaintiff's attorneys search for cases that will yield a high jury award (we've all seen the ambulance-chasing TV adds), and they will often throw any case against a wall (nuisance suits) to see what sticks. In some instances, attorneys make millions themselves off of the jury award, which also takes money away from the person who supposedly suffered the injury. This system can be "disincentivized" by allowing them to first recoup only their costs in preparing the case and exhibits, as well as a small percentage of the jury award up to a capped amount (say $100K maximum) per case.
7) Allowing collective bargaining and more privatization of healthcare by doctors and doctor's groups. This would be in the form of specialty hospitals set-up specifically to provide focused, specialty care (such as outpatient orthopedic surgical centers) to treat specific conditions. Big hospital administrators don't like this because it takes away the lucrative patients from them, but tough ****. If they got more efficient at treating patients in their own hospital, this wouldn't be a problem. Likewise, the whole scheme of "paying on the DRG" needs a huge enema itself. This breeds record falsification and drumming up ICD-9 codes to get more money. Likewise, fixing such a system would even the playing field. For example, if that orthopedic patient subsequently has to get transferred to the hospital for an unexpected complication, the surgeon has to split the bill with the hospital. You can't eat your cake and expect to still have it as well.
8) Do away with JCAHO and other "supervisory" outside agencies that only show-up to meddle in the affairs of the hospital, which puts on a smiley face for a week or so, and does not really do anything to effect change at an institutional level. All they do is hand out more policy and bureacracy, make or day-to-day jobs harder to do, limit our ability to deliver timely and effective care, and add overall cost to an already burdened system. What you do instead is give the patient (and/or their family) a handbill of quality measures at the beginning of their hospitalization and ask them to complete it at the end of their hospitalization. The grade needs to come from the patient, not some pencil-pushing, knee-jerk bureaucrat who sits behind a desk most of the day and only goes to the hospital to "check things out" after it's put on its pretty face. This is more effective than anything JCAHO can mandate, trust me.
Long story short, the current problem we're in has taken YEARS to get this way, and it is the result of a lot of short term fixes at times of crises (starting in 1964 with Johnson's now-entrenched social reform changes) that have resulted in long-term bureaucracy. The changes I suggest are revolutionary, broad, painful, and sweeping. But, they would start to serve to re-invigorate healthcare by not only stimulating competition, but also leveling the playing field and putting some things back in check that have long been out of whack.
-copro
