My practice has spanned 25 years as of August 1st. That is a significant amount of time, almost half of my life, and it gives me some perspective on the problems we all face in health care. Here is a list of issues I believe are critical.
1. Many Americans, maybe most, have relinquished to one degree or another their accountability to pay for their health care needs. It has been an insidious change and is a result of the insurance companies taking more and more of a role in determining where and what health care we should obtain. These insurance companies are not doing this to help us receive the best health care but to make money. That is why they are in business, to make money, not to provide health care. So, as we have gone along over the years we default our decisions about tests to be run and treatments to be administered to what is covered. The doctors, to a lesser degree, are guilty of the same. We have insurance and we get tests and treatments when we need them. The problem is that often these tests and treatments are really not necessary. There is so much waste and we cannot afford it anymore. The average family health premium will exceed 700.00$ per month and it will only get higher. If the burden of paying for tests and treatments were to shift back primarily to the patient, significantly more thought and care would be used to make determinations and fewer and fewer unnecessary tests and treatments would be given.
2. Contributing to the above problem is our societies general belief that if something bad happens somebody should pay. In medicine that turns out to be the doctor or the hospital. Therefore, many tests are run and some treatments administered to avoid any "misses", however unlikely they are to occur. For example, 20 years ago when one went into the ER to evaluate abdominal pain, a careful history and exam were performed as well as a few simple blood tests. This history, exam and tests was usually sufficient to rule out an acute appendix, an ectopic pregnancy a kidney stone or an ovarian cyst. Maybe less then one percent of the time a serious problem was missed and a delay in diagnosis occurred. Now, a C.T. scan is routinely performed to rule out these problems at a cost of 7 or 8 hundred dollars simply for the test. After all it is "covered" and expected and the doctor has no disincentive to order the test. It is only getting worse and I'll say again "we cannot afford it"!
3. So what is going to happen? Each of is going to decide we cannot afford the premiums on our health insurance policies and we won't pay them. The government is going to try to make us pay them either thru taxes or penalties or both but the simple truth is we don't have enough money. As the system, "govt." goes bankrupt we will be left to our own devices on how to take care of ourselves which is how it should be anyway. We will find a doctor who is trustworthy and capable, "not perfect" and consideration will be made carefully on what the problem is, what tests may be useful, what can we afford, and what if any treatment is needed. Isn't it ludicrous that we have allowed the health insurance industry to take such a sizeable portion of our health care dollar (some estimates as high as 60%) to tell us who to see and what we should have or have not done. I am looking forward to the changes coming that will happen whether we want them to or not. SD
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