Thoughts from a surgeon in private practise…
As a doctor I am terrified by the latest socialized healthcare proposals. The current administration would have us believe that the government can deliver healthcare more efficiently and less expensively than the private sector. The government is not new to healthcare. Medicare and Medicaid were enacted in 1965. There is a 40 year history proving that government healthcare is not efficient or cheap.
That said, I am not opposed to the concept of universal coverage. It is a laudable goal, but there will always be a segment of the population that remains without healthcare. Steps can be taken to increase healthcare coverage and control cost. First, define goals. Second, define priorities. Third, allocate resources to the project. Fourth, do as much as you can, using the priorities and goals as a guide, with the resources you have.
The stated goals are to achieve coverage for the most people for a tolerable price. According to government statistics, there are approximately 45 million uninsured people in America, 15% of the population. 45 million people are on medicare and 56 million people are on medicaid. The government currently provides coverage for a third of the population. This would increase to about half the population if all of the uninsured were covered under a new or existing government plan. To achieve the goal of universal coverage, let’s assume that everyone who does not have health insurance through employment, marriage, or private purchase will be included in the new plan.
What should be covered? Basic services such as annual doctor visits, immunizations, prescription medications, radiology services, specialty services, and emergency care need to be offered. The specific services offered and excluded will need to be clearly defined.
Any doctor reading this will state that cost savings cannot be acieved without malpractice reform. Defensive medicine requires the application of the latest test for every minor problem. Without malpractice relief, there will be no ability for doctors to reduce the inappropriate use of such testing. There will be no ability to reduce specialty consulations. There will be no ability to limit formulary prescription. Essentially, the nation will be committed to the most expensive healthcare imaginable.
EMTALA needs to be radically changed. The emergency room is heavily abused by the uninsured and government insured population. There needs to be a mechanism to drive this population to their primary care physicians, designated clinics and hospitals. The emergency room needs to be able to turn people away when they present with non-emergent problems. This will be crucial when wait times to see primary care physicians increse under government healthcare.
People need to be retrained. If the resources are limited, wait times will be longer. It will take longer to get a doctor’s appointment, special tests, specialty referrals, etc.
Doctors will need to adjust to the new system. We will need to wean ourselves from expensive tests that usually confirm the clinical diagnosis. This will be an adjustment for many doctors.
Some services won’t be offered. The plan will have to determine what resources remain after providing primary care, drugs, immunizations, and other essential services. Some services that people take for granted will not be available through the government plan. Eliminating this restriction destroys the budget. This will be very controversial, but it is absolutely imperative.
Now, I have offered some guidelines that will help define the nature of the healthcare problem and begin to outline a solution. I am opposed to any plan that does not clearly define the goals, priorities, budget, and limitations. The consequences of an ill conceived, government healthcare plan are decreased quality of care for the nation.
