Healthcare in America: Open Forum

While I was attending Arizona State University I had the privilege of taking an Ethics in Life Science course. This particular class was conducted as a once per week lecture session. Each week with a different topic and with its own set of experts from amongst the faculty, advisory, and expansive research staff of the University. As a result, much of what I learned there has gone a great way in forming the opinions I hold today. Much of our time was spent on topics that greatly effect the health care industry (cloning, universal disease awareness and research, gene therapy, etc.) and as a (at the time) pre-med student these topics intrigued me. And now, with the release of several new pieces of different sorts of media that high lite the American health care system, for better or worse, the need for progress and reform has become paramount. As such, I would like to present this post as an open forum. Please respond to it with any and all comments, links, facts, polls, etc. that you may have and as I siphon through them I will reprint much of that material as new posts with my thoughts and comments tacked on.

To get everyone started, here's Mrs. Nancy J. Whalley RN, BSN, CMAC, CLNC of Action Health Care Management

I believe our healthcare system is the best in the world. I have been in the healthcare setting for 32 years. My experience has been on the hospital based provider side, military medical management, and private payer based medical management. My observation is that there has been a continual evolution of ideas, regulations, and direction, etc. But the amazing thing is that there are many constants and we keep coming back to the basics on some level. The focus and trend seems now to be on consumer driven health care. In this age of technology, for example, the patient has access to his or her own health information and has an integral part in the decisions that are made about their care. The push is to what is termed "transparency" in healthcare. No more secrets, knowledge is power, and no more protecting providers as if they are above reproach or scrutiny. Consumers [patients] have access to quality data related to their doctors and hospitals. The idea is to make the consumer [patient] able to choose their providers based on measurable data. Not unlike buying a car or choosing a school for your children. The result, eventually, will be that providers have even more incentive and requirements to be really good at what they do. I believe that keeping health care competitive will ensure that quality is always a focus.

As for the payer system we have, although not perfect by any means, I would not want us to even think about a one-payer or government sponsored payment system. I have heard from many Canadians, for example, that in spite of the taxes [50%] they pay to support the national healthcare model, the quality of the care is poor and there is usually a long wait for procedures, surgeries, etc. Another example - if you [citizen of another country]become ill in Mexico , you must pay for your care up front before you are allowed to leave the hospital or clinic. If the US insurance company won't write a check on the spot - which we have seen them do in some cases - the family has to come up with thousands of dollars before their loved one can be released. We [USA], on the other hand, never deny care to anyone whether they can pay for it or not. That's both a good and bad thing. Many of the best doctors in the world come to the US where they can actually make a living as MDs. In most other countries that have controls on the healthcare system, the doctors have very little impact.

It appears that the healthcare system is in a period of struggle for survival of the fittest. Large hospital and healthcare corporations are taking over the smaller healthcare systems that can't compete with the growth in technology. There is a shortage of nurses and MDs in many areas, reimbursement from insurance companies is becoming less, and the regulations that will improve the quality of our care also contribute to the costs of providing that care. Smaller providers have difficulty keeping up. I think we will see fewer insurance companies but bigger ones in the healthcare arena. They are merging and buying each other up on a daily basis. That may eventually drive the cost of insurance down, who knows. In addition, the cost of pharmaceuticals and the impact that industry has on the cost of healthcare is enormous.

The trend in cost sharing is to pass on more of the expense of health care to the individual consumer. Although I believe in helping those who cannot help themselves, or deserve special consideration [such as the Military personnel, aged, children, the poor, etc..], However, I am a firm believer in each of us taking responsibility for our own health. We pay an enormous amount of money for vacations, automobiles, homes, leisure activities, plastic surgery, tobacco products, you name it. But "we" - in general - have poor health habits and then expect our insurance companies to pay for lung transplants, liver transplants, heart surgery, gastric bypass surgery, Diabetic supplies, etc...Not to mention the lesser illnesses that are caused by things we do to ourselves. And even though some of the money we earn goes to the insurance company for that coverage - the cost of the care we receive, overall, is way out of proportion to what we contribute. You and I are paying for those people who prefer to eat at Carl's Jr every day and weigh 300 lbs. I believe we should have a system that rewards good health habits with better coverage and vice versa.

This subject is very complex and not a simple one to dissect. There are many opinions and theories, there are many things that need to be fixed and many things that work very well, and who knows who has the answers. I would keep an open mind.