By Charles T. Rowe, MD
Regarding the guest commentary by Lynn Wilson on Jan. 14, I would take issue with almost everything said with the exception of his observation that tort reform is needed and living wills are extremely important.
First, his noting health care problems in the 2nd and 3rd world countries of Russia and Vietnam as compared to us is disingenuous. It is far more appropriate to compare us to other 1st world countries such as Japan, France and Switzerland; and when that is done, objective sources say we do not do as well overall and our costs are much higher.
There are, of course, pros and cons inherent in all health care delivery systems and it is true there are waiting lines in Canada for non-emergency procedures; but many other 1st world systems do not have that problem. Other countries derive huge savings from drastically reduced administrative, insurance and billing costs as well as much more rational malpractice approaches. Also doctors make less money, although this usually affects specialists rather than primary care doctors who are the keystones of any health care system.
Doctors’ decreased incomes are also somewhat offset by the way medical schools are funded elsewhere in the 1st world; doctors elsewhere do not graduate with an average student debt of $160,000 as is the case here; and I am not aware of any significant decrease in the 1st world’s ability to attract bright students to the profession. I refer all of you who are interested to T.R. Reid’s excellent review of multiple systems throughout the world in his book The Healing of America. But the short answer is this: even though improving technology is impacting the cost of medicine universally, the rest of the First World is providing better care across the board for their citizens and doing it at 40-60 percent of the cost of American health care.
It is true that, for those of us at the top of the financial heap, health care without peer can usually be purchased readily and usually health insurance can be purchased unless, of course, you have a pre-existing condition and are more likely to need health care and insurance, in which case maybe you can’t buy insurance.
It is also true that anybody showing up in the emergency room of an American hospital will be cared for regardless of his or her ability to pay. Americans without health insurance, also usually without private doctors, go to the ER for both emergencies and more minor concerns. If those with insurance have to go to the hospital, the insurance companies have negotiated significant discounts for services rendered. So, who gets charged the full sticker-price? You guessed it: those less well-off who have no insurance.
And, as noted by Joe Bageant in his book Deer Hunting With Jesus, “medical bills are the leading cause of personal bankruptcy in the United States for the uninsured.”
ERs and free clinics are a lot better than nothing but there the focus is on emergencies and short-term concerns; they cannot optimally manage preventive care or long-term chronic health problems. Some examples are illustrative. A working mother I saw in our out-patient facility had come in for a CT scan. She had abnormal masses lymph nodes throughout her body. She had cancer lymphoma and she had been aware of developing abnormal masses for nine months.
She had not come in sooner because she knew it would be expensive and she did not have the money to pay for it. For the same reason, the small farmer with no insurance will not come in early with his chest pain and will only show up to get treated in the ER when he has had a full blown heart attack. High blood pressure may not be identified in these uninsured until they show up in the ER with a stroke or kidney failure.
Wilson’s citing charity given by hospitals, doctors and free clinics is correct but I call it the Scrooge Syndrome. You remember, from Dickens A Christmas Carol, on Christmas Eve Scrooge was asked for donations to help those who were badly off and his response was this: “Are there no prisons (read ERs)?.... And union workhouses (read free clinics)?.... I help to support the establishments I have mentioned: they cost enough: and those who are badly off must go there.”
We can do better a lot better! And do not make the mistake of assuming this is another entitlement scam from the bleeding heart liberals.
Nobody argues the Affordable Health Care Act is perfect. There are many obvious minor fixes that would improve it immensely, although none of these will happen immediately in our dysfunctional Congress. But even so, this Act is a vital step in our progress towards a viable national health care system that can serve all of us better and at a significantly lower cost.