The Third Leg

I am sick and tired of hearing about health care reform from people like "health care economists" and the like, who don't even realize that they have no idea about what is actually involved in the delivery of health care in the United States today. Every now and then, though, a breath of fresh air breaks through. Maggie Mahar had a guest post from a retired physician about the nuts and bolts of health care reform. His comments are spot on, but only as far as he goes.

Much has been ballyhooed written about the government's role in health care, while the role of doctors (regional variations in care, end of life issues, etc.) has been given short shrift. Nothing will be accomplished by imposing government changes on physicians unwilling or unable to incorporate them. Still, doctors and government between them are only two of the three elements necessary for meaningful change. No one is talking about the third and most vital of these legs of the stool:

Patients. In this case, Americans.

The American health care system has arisen because it cares for Americans, who have different needs and wants than Canadians, New Zealanders, the Germans, the French or the English.

Everything written about the roles of doctors and government is absolutely correct, but no one is talking about the third leg of the stool: the role played by patients and their expectations. As long as Americans insist on only "the best" medical care, perceived to include instant MRIs and stents, backed up by the threat of litigation for any suboptimal outcome, we're not going to get anywhere.

As I say, I'm sick and tired of hearing people who know nothing go on and on about all kinds of changes that are not only no different, but are only going to make things exponentially worse by perpetuating systemic flaws. I suppose I have no choice.

I'm going to have to write a book.