Topic: Health Care
With an estimated 47 million Americans lacking health insurance, most agree that the healthcare system in the United States needs some reform. But doctors, economists and other professionals differ in their opinions on how to fix the problems. Below, 10 experts offer their personal views on how to climb back from the healthcare crisis.
1. Mend the medical schoolsDr. Julie Gerberding, director of the Centers for Disease Control and Prevention (CDC), thinks the country needs more medical schools and that doctors, nurses, vets need to learn together. Beginning their education at once, Gerberding says, can encourage healthcare professionals to cooperate and develop a shared mission.
“If we are seriously thinking about building a health system, then we need to be training professionals in a collegial and collaborative manner,” Gerberding told reporters at the annual meeting of the American Veterinary Medical Association earlier this year.
2. Single-payer insuranceDr. Michael Ozer, a San Antonio-based pediatrician and a member of Physicians for a National Health Program (PNHP), says that the country needs to expand health coverage and lower its costs at the same time. The only way to do this, he asserts, is through single-payer national health insurance, or NHI. The approach is similar to healthcare programs in Canada and Britain.
According to PNHP estimates, U.S. insurance companies spend more than a third of health care dollars on administration and marketing, which subtracts money from patient care. A national system, Ozer states, would facilitate long-term cost controls on the pharmaceutical industry to ensure that new benefits are sustainable. Such a system would equal overhead savings possibly to the tune of as much as $350 billion a year. He goes on to cite federal legislation currently under consideration in Congress called the United States National Health Insurance Act (HR 676) which, if passed, would extend Medicare to more people.
3. Individual, not company, plansMichael F. Cannon, director of health policy studies at the Cato Institute and co-author of the forthcoming 2nd edition of Healthy Competition: What’s Holding Back Health Care and How to Free It, says market forces bear no consequence on rising healthcare costs. Doctors and insurance companies get away with charging high prices because government programs encourage employer-controlled insurance. More people could benefit if they kept the same insurance plan even if they didn’t keep the same job.
The government is at least taking a step in that direction, Cannon says. President George Bush and GOP presidential candidate Rudy Giuliani have endorsed reforms that would extend the tax break applying to employer-controlled coverage to individual coverage. Those measures could result in families controlling more of their healthcare money and the expansion of coverage to 7 million people, according to the Congressional Budget Office.
4. Divert the dollar to the docOrthopedic surgeon and sports medicine specialist Neil Thomas Katz, on the other hand, says that the dollar needs to go to the doctors, not the patients, the insurance companies or the government.
“The solution is simple. Doctors and hospitals need to be paid at least as much as it costs to take care of you. We should not be losing money,” Katz states.
America’s healthcare funds, he claims, go toward paying high executive salaries and to maintaining insurance company staff whose primary job is “to find ways not to pay for your healthcare.” In addition, workers’ compensation and no-fault premiums create a cycle of litigation against doctors and employees. The current system enables a government health bureaucracy to thrive.
5. Pay for the care of populations, not eventsDonald Berwick, a Massachusetts pediatrician and the president of the Institute for Healthcare Improvement, touches upon several ways to transform healthcare. One area he focuses on involves making healthcare a pattern, not a response to a particular occurrence.
Berwick thinks that individuals rely on random health events like hospital stays and office visits for care. A better system would treat patients on a regular basis and aim for high quality preventive care. This method would address “the real needs of patients over time and place, guiding them through the technological thicket of modern medicine, and making sure that they get exactly what they want and need, exactly when and how they want and need it,” Berwick says.
6. Cut costs for med studentsLike CDC head Julie Gerberding, Robert B. Goldberg, who heads the Medical Society of the State of New York, also points to medical school as the place to start change. But his argument focuses on the costs to students, not the separation of education. Large amounts of debt, he says, forces many medical students to specialize in one area instead of becoming the more needed primary care physicians.
If payment structures were changed, Goldberg says, the best and the brightest medical students might be able to afford to select primary care as their field. Giving future doctors more accessibility to electing primary care as their specialty would reduce scheduling delays, improve quality of care and allow for more efficient medical practices, Goldberg says.
7. Eliminate insurance altogetherTennessee emergency and internal medicine physician Dr. Robert Berry has taken a groundbreaking approach to giving individuals better access to healthcare — he eliminated insurance all-together at his clinic. His 7,500-some-odd patients pay for their visits themselves, because Berry does not accept insurance or third-party payments like Medicare.
The doctor, who serves on the board of directors of Consumers for Health Care Choices, a national group that describes its mission as giving consumers a voice in the health-care debate, cuts overhead costs by employing only a full-time office manager and a medical assistant/student nurse. He also only keeps his office open 32 hours each week, with 28 hours serving walk-in patients and four hours set aside for scheduled appointments. Berry’s lobbied his state legislature and Congress to allow more physicians to set up similar practices.
“I estimate that if payment for all routine medical care in this country were settled at the time of service, we would save about $75 billion in administrative costs on the doctor’s side alone,” he says.
8. More health centersNew Jersey Congressman Chris Smith wants to see more affordable, community health centers around the country. Such facilities treat patients regardless of their ability to pay medical fees and aim to alleviate the pressure at hospital emergency rooms. They also tend to help underserved, low-income and minority populations who often can not afford or acquire health insurance.
Smith earlier this year co-sponsored legislation that would extend the federal funding for health centers.
“It is absolutely essential that we expand funding and support for community health centers, which provide affordable health care to underserved communities,” Smith says.
9. Stimulating positive-sum competitionHarvard University professor Michael E. Porter says the healthcare system has it all wrong — it system favors price over value. To set the system toward the latter, healthcare providers, payers and employers purchasing health plans must all change their tact. Ways to stimulate this change include making information more accessible.
“Under positive-sum competition, both the providers and the consumers of health care would get the information they need to make decisions about care,” Porter says. “The government or a broad consortium of employers could jump-start the collection and dissemination process by agreeing on a standard set of information that would be collected nationally on a regular basis.”
10. Keep it low-techDr. Dean Ornish, the founder, president, and director of the non-profit Preventive Medicine Research Institute in Sausalito, CA, said low-technology approaches to preventive healthcare can help cut healthcare costs. Though preventive programs incorporating diet, exercise and stress management might cost more money upfront, overall costs will drop by 30 percent and may save the patient from going for tests and getting treatment with expensive machinery.
“Given the failures of high-tech medicine, these low-tech approaches are starting to get the attention they deserve,” Dr. Ornish said.
Healthcare reform will most likely require a multi-faceted approach. Medical professionals, economists and government officials have differing opinions on how best to target the issues. All of their expertise will factor in as the country continues to grapple with how to handle the crisis.
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