Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, April 10, 2009

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.


At Sat Apr 11, 12:53:00 PM, Blogger Resident Anesthesiologist Guy (RAG) said...

But wait. You mean we have to hold the patients responsible for something? GASP!

Far too American to believe that someone else is responsible for your life...and therefore we see some of the current problems in our country. Responsibility is a hard commodity to sell these days.

At Sat Apr 11, 02:56:00 PM, Blogger outre said...

It should be the informed, chronically-ill patients that's been run through the mill and back are the ones leading the reform that's going to 'make things better'. I read and hear people talking about the things that needs to be changed and I think.... you have no clue, yikes.

While we need universal access to health care, universal health care like what Canada/UK/other socialized health care nations have is never ever going to work here.

Waiting 3 months or more for non-urgent MRI? Pah! heads will roll, ambulance chasers will rejoice.

At Sun Apr 12, 12:01:00 PM, Anonymous Rian said...

Well not to take issue with your characterization of health care economists, but most *real* healthcare economists (as opposed to economists who think about the healthcare system once in a while) understand and think about all parts of the equation. In schools that have them (e.g. Harvard), a healthcare economics PhD is a degree offered through the school of public health rather than the more normal school of business and/or liberal arts.

Just sayin'. :P

And yes, I obviously agree with you. Hammering "reforms" down physicians' throats is meaningless at this point because they are unwilling or unable to adapt any more. It's time to start working on the other, equally important half of the equation to control costs and increase quality and access.


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