Dr.Garber’s Blog

Welcome back!

Health care costs, and how to get them under control, is one of today’s most important issues. It is at the forefront of President Obama’s agenda, as well it should be. The big problem is that everyone has a different idea of how costs should be controlled, with each interested group trying desperately to protect their own turf, or rather, their own income stream.

An article in the current New Yorker’s Annals of Medicine column [I know, I know - as a line from a play I once saw went, "Life's too short for the New Yorker." but, if you're at all interested in the topic, this article is a must read] discusses one the key issues surrounding the debate, the profit motive. Now, although I am a proponent of a single-payer system, there is nothing inherently wrong with delivering health care for profit. Some have even called this immoral. What is immoral is when health care decisions are made solely for profit, at the patient’s expense. This problem is pervasive within the health care delivery system, and while much of it may be unconscious, much is not.

There are, of course, many other factors that contribute. A disproportionate amount of our health care dollars are spent on treating preventable conditions. This is a well documented fact. Diet and lifestyle changes (see my previous blog posts on cholesterol) should be at the top of every doctor’s list. But even when they are, many patients, if not most, are simply unwilling to take responsibility for their own health and make the changes that will save their lives.

Related articles by Zemanta

• Voters To Congress: What’s Wrong With Single-Payer Health Care? (huffingtonpost.com)
• Single-Payer and the ‘Democracy Deficit’ (bradblog.com)

The AMA is opposed to President Obama’s plan for a government sponsored health insurance plan. And so am I! Who Me? On the same side as the AMA? Well, in this instance, yes. The AMA is opposed to the creation of a government sponsored health insurance plan, and so am I. But for very different reasons. The AMA opposes it because it will cut into doctors fees, also that of hospitals. On the other hand, I am against it because it circumvents the real issue. What we don’t need is more or different health insurance plans, government sponsored or otherwise. What we do need is a government sponsored health plan, sans the insurance part. The former still leaves us with all the pitfalls of the corporate profit motive behind medical decision making. At least the current health insurance policies, those that are coupled with Health Savings Accounts (HSAs,) which I have been a proponent of and have for my own family as the best current option, take the “Is it covered?” part out of the equation. I still remember so vividly, many years ago, a patient of mine asking after I enumerated for him his options for the treatment of his condition, which included surgery as well as a very effective non-invasive technique, what was covered by his insurance policy. When I explained to him that the non-invasive alternative to surgery was not a covered procedure, he said he would opt for the surgery, despite the risks. This blew my mind but at the same time I understood. I understood on a personal level what it meant to him financially but I also understood just how completely out of control our health care delivery system was. This man was willing to undergo a high risk surgical procedure, with an uncertain outcome, rather than elect to have a well documented, effective and relatively risk free non-surgical procedure performed, because one was covered by his health insurance plan and the other was not. It was truly a sad state of affairs. So now our country is on the verge of making a great leap towards rectifying this situation - or a great mistake. Pandering to the guise of the powers that be, rather than shooting for true reform in how health care is delivered in this country, will set us back decades. I am thrilled with the current administration’s agenda in most every arena but I fear that it’s push towards health care reform is going in the wrong direction.