America needs better health care
Published: November 2, 2009
I have just retired after 43 years on the University of Virginia Medical School faculty, and I feel compelled to comment on the proposed health care legislation. The health care system needs revamping. Health care for the majority of Americans is the best in the world.
Both as a health care provider and recipient, I have been overwhelmed by the inefficiency of the health insurance companies as well as Medicare. We’re told that there is a great deal of fraud in Medicare, costing $100 billion in losses. Why aren’t these two areas immediately addressed?
In addition, the health insurance industry needs to be more competitive — open to the state borders. Small businesses need to be able to join together so that they can receive the same health care insurance for the premiums that large companies enjoy.
Another area that needs an in-depth study is the medical malpractice industry. No one accurately knows the cost of defensive medicine, but estimates have run as high as 10 percent of the health care dollar. The cost is felt both by those purchasing malpractice insurance as well as our hospital bills. Tort reform is a key element to fixing the problem; however, according to Time magazine (Aug. 31) “Obama knows that defensive medicine is a problem, but he also knows that trial lawyers, who raised millions for him in 2008, oppose tort reform.”
It is evident that we have a multitude of issues to address and this will take time to accomplish. There is no rush to find a single bill that will cover all of the problems. It has been suggested that the problems could be divided and bills passed incrementally to solve them.
Let’s see if these incremental changes truly reduce the cost of medical care. If they do, this will be a blessing and we can move forward with a plan to provide health care insurance for those who cannot afford it.
The end-of-life issues have been totally distorted by the media. All families are in need of these discussions. They can become better informed about the issues and understand their options before they or a member of their family are in the midst of a medical catastrophe.
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Reader Reactions
Totally agree with your statement regarding nurses. A neighbor of ours is a nurse as well as a good friend of mine. They tend to be nurses ALL the time, when needed, not just when they are on duty. Thanks for sharing your insight.
Why hasn’t the problem of malpractice itself as opposed to liability for malpractice been addressed?
To a small extent it has been addressed, but virtually all the professions do a poor job of policing their own. Physicians aren’t much better or worse than lawyers, architects or any of the other professions in this regard.
Virtually all physicians would admit to knowing other physicians they’d never refer one of their family members to, but taking steps to prevent those physicians from practicing (and thereby protecting the public and not just their family members) is another matter. It is very difficult to get peer review committees and licensing boards to act for various reasons, including the same “there but for the grace of God go I” thinking that often lets drunk drivers off the hook.
By the way, the best of the medically-related professions in terms of self-regulation, in my experience, is nursing. The nurses leaders I dealt with on licensing and discipline issues for the most part seemed more genuinely interested in protecting the public than in protecting individual nurses.
Robert Oshel, your comments make a whole lot of sense. I wonder why these problems have not been addressed as you stated?
I know our health care in the US is great. It’s not perfect, but no one is denied care. Being without health insurance is NOT the same as being without health care. No one in an emergency is turned away for lack of payment or even with any quick payday loans, except maybe in Michelle Obama’s Chicago hospitals. A couple of weeks ago I had a tooth die. I called the dentist at 4:30pm and they got me an 8am appt the next day for a root canal. Their office hours start at 6:30am so I could have gone in even earlier. And my waiting room wait was about 30 seconds. When I had to reschedule my follow up appt, they were able to reschedule for the next day. And in an emergency they would have seen me right away. This is also my experience with non-dental health care. Anytime I needed to bring in one of my kids for anything - sports injury, asthma, illness, etc. - I could get an appt right away. The one time our schedule didn’t mesh with the doctor’s office, we found a drop-in clinic nearby and had an appt within a couple of hours. We have never had to wait for medical care. The biggest problem with the US system is attaching health insurance to employment. If we had a market solution, similar to pet care or car care, we wouldn’t need COBRA or have people need to take jobs just for the health benefits. An American innovation saves lives and improves lives around the world.
Dr. Berry says the solution to the malpractice problem is tort reform, which lowers costs by reducing compensation to injured or killed patients and not by reducing malpractice itself.
What we actually need is true malpractice reform to reduce malpractice in the first place. National Practitioner Data Bank data shows that in most states only about two percent of physicians have been responsible for over half of all the money paid out for malpractice since 1990. NPDB data also shows that quite often these two percent have multiple payments in their records but no action by state licensing boards to revoke their licenses or restrict their practices. Similarly, most often no action has been taken by hospital peer reviewers to revoke or restrict their clinical privileges. So the “repeat offenders” continue commit more malpractice.
To have true malpractice reform the licensing boards and peer reviewers need to get serious about protecting the public from physicians with a pattern of malpractice.
It is also worth noting that there are fewer than 20,000 malpractice payments each year for all causes although the Institute of Medicine estimates that there are about 100,000 deaths each year from malpractice. Other sources double that number. Only about 28 percent of malpractice payments involve patient death. Thus we can estimate that at most only about 3 to 6 percent of all malpractice victims receive any malpractice payment.
The real problem isn’t malpractice payments. To save money—and more importantly, to save lives and prevent injury—we need true malpractice reform that reduces malpractice itself. We need to stop treating the symptoms—malpractice payments—and instead treat the disease—malpractice.
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