America’s Healthcare Crisis – Steps Toward Solutions

America’s Healthcare Crisis – Steps Toward Solutions




Just as with our current economic meltdown, we should have seen our healthcare crisis coming. America has the most expensive and however not the best healthcare in the world. Certain forces have been at work to create this perfect storm. While plans have been hypothesizedv to increase access to health insurance and streamline information sharing by digitizing medical records, government has failed to clarify some elephants in the room that need to be addressed.

Litigation

What distinguishes American healthcare from that of all other first-world nations is the prevalence of litigation. Medical tourism is thriving because patients recognize its enormous cost savings. The same surgery done oversea can be one-tenth of the U.S. price. Absence of possible litigation accounts for the difference. The cost of drugs in general, and vaccines in particular, are astronomical because litigation has been factored into the price. Physicians in America order far more tests than those in other countries because of the fear of litigation. Any effort by congress to control healthcare costs must begin with tort reform. There has to be a cap on malpractice and negative drug effect settlements. Any new government sponsored insurance needs to require arbitration in lieu of litigation.

The Pharmaceutical Industry

Years ago, President Dwight Eisenhower warned the nation to beware of the military-industrial complicate: the industry of war fuels the need to have more wars. A similar can be seen in the pharmaceutical industry. constant drug development with escalating cost is a self-perpetuating occurrence. Antibiotic resistance is the pharmaceutical industry’s best friend. New antibiotics with increasing potency are regularly being developed to conquer drug resistant bacteria. As soon as a new antibiotic becomes marketable, drug sales representatives generously supply doctors with the new drug. This drug should truly be used sparingly and for specific drug resistant infections, but because of the convenience, doctors frequently give away and assign the new antibiotic, it becomes widely used, and the consequence is more drug resistance requiring already newer drug development. Somehow, this kind of drug overuse has to be controlled.

The U.S. is the only country in the world that allows drug advertising. Choice of drugs should be left to the treating physician without the pressure of patient need for the newest and most expensive version. Many new drugs are “me too” drugs, just slight modifications of older tried and true drugs. The difference is in cost, not efficacy. Advertising for non-prescription drugs regularly reinforces the concept that the only answer to any discomfort is a drug, a concept that has become as American as apple pie. Because of extensive advertisement, Americans unthinkingly take nonsteroidal antiinflammatories, which have possible serious side effects such as gastrointestinal bleeding and kidney failure, for such non-life-threatening conditions as the shared cold. Risk outweighs assistance in these situations. We need to revert to banning drug advertising.

Physician Behavior and Training

American physicians habitually order more tests than are necessary. Clinical guidelines based on research have helped assuage this wasteful behavior. for example, years ago, research found that routine chest X-Rays were of no assistance for annual physical exams. Similar guidelines have been established for taking X-Rays for ankle sprains. Finding what are the most unproductive tests and establishing national guidelines for when to use them could help bring down cost.

The price of our technological progress is the loss of clinical skills among the current generation of physicians. In an article entitled The decline of the Physical Exam (Jauhar 2006), the author, a professor of medicine, expresses the prevailing view among today’s physicians: that the physical examination is “an arcane curiosity,” performed as a ritual that preceded their real tool for problem-solving– technology. For centuries, doctors have been taught to begin with a thorough history and physical examination followed by tests to finally arrive at the final diagnosis based on the total information gathered. The current method virtually eliminates the initial steps. Doctors perform a cursory history taking and physical exam, and then order the tests related to the patients’ symptoms to acquire a diagnosis. With this method, I have witnessed not only excessive waste from unnecessary tests but also the misdiagnoses of shared conditions such as small bowel obstruction, congestive heart failure, and appendicitis. This sea change in medical practice consists of one major reason why American healthcare has become so expensive and however less than satisfactory. There is a dire need to retrain physicians to return to basics. And the need is urgent because the medical trainers are losing the very skills they should be teaching.

Over half of the American public recognizes that the Western medical approach has limitations and seeks complementary and different care. Skeptics among the medical formation scoff and explain away the trend by saying that these patients “weren’t very sick to begin with.” What they fail to recognize is that Western medicine, while having progressive treatments for progressive diseases, have far fewer remedies for early-stage disease, or, the “not very sick.” Traditional Chinese medicine teaches that illness begins with some dysfunction in the great number that causes him or her to succumb to disease. Unlike the Western approach, which focuses only on disease, Eastern medicine also strives to restore the patients’ weakened function to regain health. Familiarity with this approach among dominant care physicians could not only bring down healthcare cost but also enhance physician satisfaction with work. If the physician prescribed herbs for the shared cold, there would be fewer situations of bronchitis, the leading condition for which antibiotics are overprescribed. If acupuncture or acupressure were first-line treatment for back pains and soft tissue inflammation, patients would enhance. This would rule to fewer MRI’s ordered and fewer surgeries performed. If acupuncture and herbal therapy were first-line treatment for infertility, it would eliminate the enormous cost of in-vitro fertilization in many situations. In the past decade, the insurance industry has begun to recognize that some forms of complementary care obviates far more expensive treatments such as surgery and are adding them to its covered benefits. It is time for government-sponsored insurances to awaken to this fact.

In the past decade, the number of medical school graduates entering family medicine and internal medicine training has dropped by half. The shortage of dominant care doctors has led patients to overuse costlier secondary and tertiary care facilities such as emergency rooms and hospitals. Several factors explain physicians’ disenchantment with dominant care. Compensation is low when compared with specialty careers. Bureaucratic paper work is daunting. Often dominant care physicians are frustrated because they have no method within the Western paradigm to treat shared conditions. The very reason for entering the medical profession, to help heal and relieve pain and experiencing appears unachievable, and they see themselves as insignificant triage agents. If these physicians were able to use complementary and different medicine, the gratification of seeing their patients truly enhance would certainly raise their level of job satisfaction.

Other players are insurance and patients. The private insurance industry has recognized that prevention is more cost-effective than cure. Many offer prepaid health plans and cover routine physical examinations. Medicare, to date, retains its outmoded policy: coverage for disease and not prevention. It is time for Medicare to go into the 21st century. Patients used to pay the doctor directly for sets. Now, usually a third party, the insurance pays. Now, no longer aware of costs, patients feel entitled. If they have insurance, every test and treatment should be covered. The media sensationalize such situations, portraying the patient as victims and insurance companies as demons for not covering exotic treatments that have a low prospect of cure. Such situations often consequence in litigation, of course, further driving up cost. It is time to educate doctors and patients alike about cost and to behave responsibly. Correct treatment requires correct diagnosis. This basic rule applies to finding solutions to our healthcare crisis.




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