Much has been written about our soon-to-be-thrust-upon-us “change” in health care delivery. I keep hearing about how our system is “broken,” untenable, limits access to the “47 million” uninsured, and needs immediate change. And yet somehow I do not see a broken system each day.
Currently, I see people coming to emergency rooms and being cared for faster than ever. I see people who actually are appreciative of the health care they receive more than those who are disgruntled. I see doctors working late hours to clean up their work as they struggle to get home in time to catch the end of their daughter’s play. I see surgeons reaching in bellies at all hours of the night with miraculous instruments as they pluck an inflamed appendix from the depths of the pelvis. I see state-of-the-art facilities, instruments, and automation. I see quality of life changed by neural stimulators that permit a patient with Parkinson’s to walk again. I see lives restored by biventricular defibrillators that can be checked from the patient’s bedroom or the countryside. I see teams of people devoting enormous amounts of energy to achieve health care “perfection” preventing infections, bed sores, medical errors while simultaneously trying to control costs. In short, I see a team effort of all involved, working together with the common goal of trying to take care of patients well in a remarkably competitive environment fraught with unbelievable regulatory requirements only rivaled by the nuclear power industry.
You know, do we see the glass half empty, or do we see it half full? I think, right now, right here in the good ol’ U.S. of A., we’ve got a pretty good health care thing going. Most kids get vaccinated, people are getting the anti-smoking message, people are living longer, and patients are empowered with information like never before. Oh sure, we've got a long way to go, but haven't we done some miraculous things with our current system? But we fail to see this for what it is. Instead, we hear that fetal mortality higher in the US than other “developed” countries, that we spend more per capita than any other country in the world with “poor quality.” And yet, I see more ninety-year olds on the wards now than I ever did as a medical student or resident. Is this just me? Is this because we’ve done a bad job at caring for these individuals? At least a few brave souls have disputed some of the assumptions. And there are certainly plenty of others who want to make sure we understand the problems. (Like there won't be any problems with the alternative). Oh sure, there are the scandals, the mistakes, and patients with just plain bad care, but taken as a whole, is America’s health care as bad as we’re being led to believe? Could at risk for throwing the baby out with the bath water?
I wonder because while some report there are 47 million uninsured, why do we never hear about the 253 million who are insured? Oh sure, many have to pay higher premiums and co-pays, and those payments are rising faster than water in the Titanic, but could there be another alternative policy for change that preserves the good in our system while meeting the needs of the disadvantaged? Is a health care system like the Department of Motor Vehicles drivers license facility or the VA Health System really what each of us wants?
As we ponder this vision, perhaps we should ask ourselves if these “lowest common denominator” policy initiatives in vogue right now might lead us to just that.