Does it even matter? We as physicians take a tiny piece of the health care pie (less than 10%). Even if we reduce our take home by 50%, little will change. This has been going on over the last several decades, our salaries have been shrinking, costs have been ballooning, patients paying more. How about we start by looking at the fat that we can trim outside of the physician's income. It is outrageous that we have been conditioned to believe that we as physicians giving up more is the way to solve the health care crisis.....the more we give up, the more those dollars find their way into some executive MBA's pocket. To hell with that.
You are right, morpheus. The documentary touches on this, namely that 24% of healthcare dollars go to administration of healthcare and never actually reach the patient.
I agree with the program that we need a "herd" mentality with regards to coverage (i.e. that
everyone needs to have insurance and pay into the system... something that isn't happening now until people get to the age where they start to get sick). I don't know how you meaningfully accomplish this with current private, for-profit insurance companies that consider people who extract money for services as a "loss" (which the program also discusses).
I took care of a guy today, 55 years-old, prior AVR/MVR, morbidly obese, CHF (NYHA Class III), and poorly controlled diabetes. The guy, in no other words, was a fat slob. As I was sitting there interviewing him in the pre-op area, his daughter was chastizing him for waiting so long before coming to the hospital. He was hella-sick by the time he got to me. And, what could've been a routine problem relatively easy to fix, is now - literally - going to cost hundreds of thousands of dollars.
And this guy knew better.
He was already "in the system", so to speak. He had doctors at our hospital already seeing him. He'd been operated there before. He was being followed, although a review of his scheduled visits in our computerized patient-visit tracking system revealed a shotty record of attendance. Fact is, he was just too goddamn lazy to come to the hospital until he was near death.
That's the unquantifiable intangible that I don't think programs like this can quantify, and I'm not sure how you can change it. It would be okay if occassionally people presented to the hospital this way, but the fact is our country is full of fatter and sicker people than ever... and it seems the
majority of them are presenting to the hospital this way. I go to the grocery store and I routinely see train wrecks that are just waiting to come across our doors.
We need to get tough. Part of that is a "carrot and stick" approach. One "carrot" is that people pay for their own health insurance - mandated coverage - but they get to write it off. The "stick" is they are fined if they don't have coverage, just like you would be if you got pulled over by the police and didn't have automobile insurance.
Another "carrot" is that people get an additional deduction for maintaining an ideal body weight, and a fine for being for being overweight (the "stick").
Yes, there was no mention of the providers as part of the solution. Likewise, this problem is so complex that the program only skimmed the surface of many of the issues we face. But, we need to seriously put part of the onus of "change" back on the individual in the system. People need to grow up, take care of themselves, and live better lives through effective preventive medicine.
But, as the old saying goes, you can lead a horse to water but you can't make him drink. And, Americans, on the whole, have been programmed that they can get whatever they want no matter what the cost even if they can't afford it... and the fixes proposed, remaining under the current system, we can't afford.
-copro
