I’m not really a political man. I don’t join parties. I don’t like ideology. I take ‘political aptitude tests’ when I’m bored. One time I tested as a “Liberal Economic Libertarian.” Another test, I surfaced as a “Moderate Republican.” It really depends on the issues.
Take health care reform. I’ve actually done some research in this area – mostly in the service of clients but also in covering healthcare issues for OC Metro and Brentwood Magazine.
A friend of mine knows that I support the present legislative effort to reform healthcare. He does not. After some email sparring over our counter opinions, he sent me a link to an article written by a technologist named David Goldhill published this summer by Atlantic Monthly entitled How American Health Care Killed My Father. Almost as dramatic as my OC Metro article “How Men Die.”
Goldhill’s article reads well, but I found it filled with errors. Moreover, many of his assumptions are based on simple anecdotes and nary any serious research.
For instance, while he decries any government involvement in health care delivery, he concedes that a ’single-payer’ system – e.g., a public insurance system – might provide a better solution (but doesn’t state why). Then he goes on to make the very common mistake of using Medicare and Canada care as examples of how costs will increase and care will decline under single-payer. It’s a bad assumption because it assumes that upward trend for demand will be constant.
While he correctly describes the cause of the present crisis – distorted demand – he fails to identify where the distortion came from. If he had, he wouldn’t have come to the conclusion that he makes (i.e., no government involvement, let the markets decide). For that lesson, you have to roll back the calendar to the early 1970s when “managed” healthcare took over the doctor-patient relationship. Instead of a personal relationship with your doctor (ala “Marcus Welby MD”) – there was a switchboard, an appointment desk, a patient timeline and productivity quotas. Doctors who wanted to participate in the new system were DISCOURAGED from offering preventative healthcare advice because the Managers said that such interactions were off task and wasteful (Greenfield, Kaplan, et al, 2003).
That’s how the two errors are related – when Goldhill notes the benefits of good patient-doctor relationships but fails to mention that every patient care research conducted for the last twenty years has found that good doctor-patient relationships (as opposed to cost-containment measures) tend to curtail demand (Gerteis, Edgman-Levitan, et al, 1993). Moreover, improved patient-doctor communication also produces measurable improvement in clinical outcomes (Greenfield, Kaplan, et al, 1985; 1988; 1989) – thereby reducing demand again.
And as most of us know, when demand goes down, overall cost to the system goes down.
That’s why I’m engaged in the present debate – working with a handful of non-partisan physicians and researchers to ensure that any meaningful reform includes provisions that removes the distortions created by managed care in the first place. Our assertion is that not only should we encourage greater doctor-patient interaction, but reward doctors for dispensing wellness advice and resources. I also believe that American health care is due for some ‘deprofessionalization’ – especially in areas of dispensing wellness services, treatment maintenance, non-critical care (Ehrenreich, 1978; “The Social Economics of Health Care” Davis, 2001).
By the way, variations of this concept are found under “Wellness Programs” or “Patient Wellness” in one proposal now circulating in the House and in the current draft of the so-called “Baucus Reform Proposal.”
Clearly, this is not an issue for laissez-faire capitalism to solve – yet many people have been hoodwinked into believing that it is. Just remember that we’ve tried that experiment already and look where it has left us. Universal greed makes the private sector ill equipped to provide a fair and timely solution for Universal Care. That’s why we need to support the current legislative effort and engage Congress and the President – to make sure that old mistakes are not repeated. - HP
