A Broken System

The American healthcare system has been a frequent topic of discussion here at Impatient Sufferance. We have continually addressed what we believe to be serious deficiencies in the provision of adequate care and the maintenance of a healthy citizenry. Our efforts have included an analysis of the money-motive (i.e. taking in more cash from consumers than paying out in ‘medical losses,’ calculating risk to ensure maximum returns) that propels the American insurance industry (guaranteeing soaring profits and millions uninsured), as well as the enormous monetary inefficiencies associated with market-centric healthcare policies (compared to state-sponsored programs), which result in both higher (total and per capita) costs and, perhaps more important, patients with a lower healthy average life expectancy (HALE) than those in comparable post-industrial nations.

Each of our discussions have approached the fractured healthcare issue from a larger, more macro-oriented perspective, critical of the businesses and socio-political institutions that promote high costs and leave millions without security. We, and many needy patients, are obviously for reform. A question, however, remains: what about physicians?

If we were to scrap our current system, would they suffer professionally? Would not they be opposed to a single payer system that could potentially slash their income, and, perhaps, prevent them from providing top-quality care with access to the latest technology? Given the release of recent data which suggests that an increasing majority of doctors (nearly 60%) favor a universal healthcare system over market-based insurance plans, it seems that these concerns, while present, have lost traction in the medical community. In order to understand how a single-payer system could benefit, rather than hinder, physicians, we thought it best to seek a (micro-based) opinion from a medical professional. Without further ado, here is frequent Imp commentator, Doc Hopper, a bona fide and well-respected doctor with several decades of medical and health-administration experience:

The American healthcare system is broken.

Despite accelerating medical costs, unparalleled access to diagnostic and therapeutic technology, and the best-trained physicians in the world, the patchwork quilt of American healthcare has managed to produce almost fifty million uninsured, and clinical outcomes that lag behind those in many industrialized nations.

It is clearly imperative to control medical costs without sacrificing quality of care. Physicians bear a significant responsibility; they must limit the use of high-cost technology when a less expensive option will suffice, and must resist the multi-faceted marketing onslaught from pharmaceutical manufacturers. Medical malpractice reform is a necessary part of any comprehensive solution, but physicians cannot invoke the superheated medical liability environment as an excuse for not acting responsibly.

The insurance industry bears the greatest share of responsibility for the cost of medical care in the United States. Profit-driven insurance companies spend precious healthcare dollars on schemes to delay or deny payment to providers, and to provide return-on-investment profits to shareholders. Organized American Medicine has militated against the development of a single, government-sponsored insurer available to all Americans. In postwar England, similar sentiments followed the introduction of the National Health Service. To silence physician opposition, British Minister of Health Aneurin Bevan “filled their mouths with gold” before severely reducing physician incomes. [Webster C. The National Health Service: A Political History. New York, NY: Oxford University Press; 1998.] American physicians are fearful of similar income loss, and have rallied against universal health care for Americans.

However, the emergence of a single, national healthcare insurer would result in significant benefits for physicians, potentially mitigating physician income losses:

• medical office expenses would be significantly reduced by the elimination of redundant insurers, policies and procedures
• reduced profit-driven oversight procedures would allow the unfettered practice of “good” medicine, and improve physician efficiency
• a single insurer would provide the potential for improved coordination of medical care and the broad-based application of “best practices”
• a national insurer would have great power in negotiating drug cost reductions with pharmaceutical companies
• the number of uninsured (i.e. non-paying) patients would be drastically reduced

It is imperative that American physicians recognize that they must be a part of the solution, or will increasingly be seen as a part of the problem. They must return to their previous position of patient-advocacy and promote means to provide cost-efficient, effective health care to all Americans.