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Oct. 2, 2009 “Ask the people on the firing line!” – is a truism uttered when confusion reigns among bureaucrats, administrators, politicians, and pundits when dealing with complex social issues. The debate on health care reform now raging in the offices of congress, radio and television studios, in the media and at town-hall meetings across the land is such a time. So herewith are the words of one from the firing line. After receiving my M.D. degree from Boston University School of Medicine in 1952, and after six years of training in Internal Medicine and in Neurology I earned my certificates as a specialist in these two fields of medicine. I then opened a private practice of Neurology in northern California . I retired in 1998. That’s forty six years of hands-on experience. Given the intricacies of health care, the myriad issues of cost and financing, the countless variables involved in coordinating the functions and responsibilities of individuals, communities, institutions, and government entities, it’s not surprising that we have been barraged in the debate on reforms by a host of inadequate solutions, incompatible schemes, contradictory plans, and non-comprehensive programs. The fact that after fifty years of national experience of failing health care delivery, costs overruns that are bankrupting our national treasury, multimillions of uninsured and unprotected individuals, highlights our woeful unpreparedness to deal with this dilemma. Little consolation will be had that similar situations, in one form or another, exist in every advanced country that attempts to provide universal health care to its inhabitants. Still, there must be a way. In the meantime, permit me to draw your attention to four issues, or rather to their absence, in the ongoing debate. These are: DENTAL CARE, MENTAL HEALTH CARE, DOCTOR-PATIENT RELATIONSHIP, PROFIT MOTIVE IN HEALTH CARE. I dub these factors ‘the black hole’ of health care because, like a black hole, over time, they will insidiously grow, quietly devouring all the other aspects of health care and devastate the entire system. DENTAL HEALTH CARE – Study after study has documented the ubiquitous presence of oral infection in most of the population.. It is the source of general poor health and physical under-development, systemic infections, including fatal ones such as brain abscess, heart infections, and pulmonary diseases, among others. Periodic dental check ups and preventive oral care would mitigate against such dire developments. In the long run, that would also reduce the expense of health care. MENTAL HEALTH CARE – High cost of psychiatric care has historically precluded it from being adequately covered in insurance health plans and in most government subsidized programs. In recent decades many state mental institutions have been closed and county mental health clinics have been cut back. As a result behavioral disabilities, acting out deviants, individual pain and suffering, and familial hardships followed. Untold numbers of drug and alcohol addicts and preventable deaths occurred as a product of such poor conditions and meager care. Additionally, this situation has developed into an enormous financial burden on county, state and federal governments, paid for by the taxpayer. All the while, unconscionable tolerance for such inferior medical and psychiatric care has persisted. However one might view this situation, it is unethical. An enlightened society ought not to put up with it. Mental health care, from early on in life, including timely intervention and adequate therapy by competent professionals (not just by aids and nurses) would restore many to normal functioning and enhance their physical well-being. It’s clear that would over time also reduce costs significantly. DOCTOR-PATIENT-RELATIONSHIP – Everyone agrees that a doctor-patient relationship should be respected. It isn’t just a slogan. None of us is predisposed to reveal his or her innermost secrets, private feelings, or want to share deep anxieties and mortal fears with others, let alone strangers. Yet that is exactly what is required of us when we consult a physician. We never know when illness will strike or when it will turn serious or threaten to take our life. We cannot prepare ourselves for such a demanding time. To whom else would we turn to for comfort, confide in, expose our hopes, and lean on to keep us alive? We place ourselves in the hands of a physician. How can such a relationship not be honored? Nothing kills this delicate balance between a patient and a doctor faster than a third party’s interference, especially when it is an insurance company or a government bureaucrat. Beware. PROFIT-MOTIVE IN HEALTH CARE – I know of the waywardness of socialized medicine, its profligate ways and corruption. I know that profit is what drives the entrepreneur to conduct a well run business. That’s exemplified in the business of selling automobiles, diamonds, toothpaste, and so on. But health care? Nevertheless, there are exceptions. Is there a profit motive in the running of police departments? Fire-departments? The FBI? The US military? And what about the U.S. Congress and the Government with its one million employees? Clearly, in a capitalistic society like ours, there is room for such institutions without us becoming socialists. Why not consider this for the delivery of health care? Is life any less precious if it succumbs to cancer than in a fire, or in a robbery? I suggest we study the idea of establishing CO-OPERATIVES OR NON-PROFIT CORPORATIONS for the delivery of health care. The members would be physicians, surgeons, nurses, dentists, psychiatrist, technicians, other professionals, laboratory services, X-Yay and imaging, physical therapy, etc. All aspects of health care would be provided. What could vary are size, location, under one roof or scattered, and availability to the community night and day. The professionals would be equal members of such a group. They would elect a board and be responsible to the membership. Patients would pay a nominal annual fee to join. The board of the entity would enter into an annual renewable contractual arrangement with the government, represented by the New Medicare Office, who would pay for the care of each patient according to the provisions of the contract. A mutually agreed upon annual external audit would be conducted of the fiscal state of the entity. Peer review is the most effective method of maintaining a high professional standard. Select committees of esteemed members of the clinic would review the files and work of members of the clinic to maintain a high standard of the care provided to the patients. I’ve no doubt there is much of the above to discuss, even dispute. A great deal is in need of judicious discourse. We can do no less but seek to remedy the problem facing our nation.
It’s the right thing to do.
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