Healthcare reform - the first problem

The following is the first in a series of blogs about healthcare reform. I'll be adding more, usually about one a week, since they're rather heavy.

Well, it was bound to happen sooner or later. I was asked by a patient at the county clinic this morning what I thought about the upcoming healthcare reform. Actually, I'm surprised I haven't been asked this question before, seeing as the majority of my patients are on Medicare, or are lower-income individuals and without insurance. My reply was somewhat brief, seeing as I didn't know how in-depth she wanted the answer, but basically I said that the entire system needed to be reworked, including the way that we view patient care. She said that she agreed, and that was that. After she left, I started thinking more about the issue, and these are some of the thoughts I came up with. Warning: disillusioned opinion ahead.

So many of the issues our government endlessly debates relate to costs, state allowances, and eligibility for healthcare coverage. While these things are no doubt important, the real focus of the reform should be on the patient, and not on how much the government can save (or earn) from the insurance system. I understand that the people debating these topics are for the most part not doctors, and therefore their focus isn't on health CARE, but rather on heath COVERAGE. Here lies problem number one: how can we expect the system to change, when the people attempting to change the system have little to no knowledge about the components (patients) of said system? Even though they work with plants every day, we don't expect gardeners to debate the consequences of global warming. Why, then, should we allow lawyers and politicians to determine how you and I receive medical care? It simply does not make sense. Oh sure, I understand that politicians know how to write bills and talk for a long time, but that doesn't qualify them to make decisions about how I practice medicine. "But the senate has lots of think-tanks and people with multiple degrees helping them make decisions," you say. That's all great and good, but how many of those people are physicians, let alone practicing ones? I personally wouldn't want my care decided by someone who hasn't seen a patient since medical school, even if they had won the Nobel Prize in Medicine.

We have to do something about this.  I’m sorry if I sound like a broken record, but non-medical people should not be making decisions about medical things. The insurance world already has "veto" power over physicians by requiring pre-authorizations (basically a "mother may I?") before the physician can order a test, perform surgery and so on. On the positive side, at least there's a medical director for each insurance company that you can reason with. If we allow politicians to run our healthcare, however, how are you going to reason with them? I guess "I'll vote for you in the next election if you let me have that appendectomy," will have to do.

And now for the County Clinic quote of the day:

Me: "So you say your son developed that rash last night?"
Patient's Mom: "Yeah, right after dinner."
Me: "It looks kinda...orange...and crusty."
Mom: "Yeah, I know! It's so weird."
Me (to the patient): "Have you been picking at it?"
Patient: "Yeah, it tastes like Cheetos."
Me: "I think he'll be fine."

Until next time,
-DD