Archive for September, 2009|Monthly archive page

Observations on Health Care Reform

In Health on September 19, 2009 at 7:57 am

The proposed medical care reform program, for which the president is trying to find acceptance, seems to be the biggest fear most of us have, even more threatening than international terrorism. Yet getting access to the most skilled physicians of our time is more difficult, the more talented they are. In a managed care system, we at least have the potential for steering some of their time to those who need it, but otherwise would not get it. In a competitive system, such as our present model, we have the burden of being our own advocate with no guarantee that we will gain access to the experts we need.

The “better” doctors are difficult to enlist in our care because they spend a lot of time as inaccessible. These are the medical professionals who are pursuing fame and glory writing papers and presenting them at seminars, performing studies, performing consulting on the more interesting cases, i.e., those that provide the most interest in terms of career advancement (which is their right in the pursuit of happiness), and pushing many of their duties onto nurses and aids. This isn’t necessarily “bad” and may be what is necessary to encourage the pursuit of advances in medical treatments, but what it means for someone with a serious illness is that in a capitalistic society we compete for resources, whether or not we “manage” health care. The main question is, who will make the decision to allocate those resources?

Which brings me to one last observation before I get off my soapbox: free enterprise is not always in our best interest, just as selfish-self interest is not always our worst nightmare. To claim otherwise is naive. To write off the entire civil service, for example, because we are sure they will screw up the the health care system is ludicrous. From what I have seen over a 30+ year career in managing contracts with the government, the best results are obtained from fostering a “we’re in this together,” partnering atmosphere. If we sit back and expect failure, we will get failure. Better to deal with each individual case where we feel things could have gone better.

Let me summarize: A well-crafted health care program would not only make basic care available to those who can’t afford it, but also would make catastrophic care (i.e., the specialists) more accessible regardless of income. I suppose that’s too much to hope for, and the economics of such lofty goals would be potentially bankrupting, so the focus will remain on basic care issues—the lesser in importance of the two. But we have to start somewhere, and it’s difficult to argue against providing basic care to anyone who needs it.

Copyright © 2009 by Tad Laury Graham