A Health Care System that Cares

April 20, 2018

This doctor believes the American health care system can and must do better in terms of providing for patients.

Recently, a Goldman Sachs memo reportedly asked, “Is curing patients a sustainable business model?"

For this exact reason, health care cannot and should not be viewed in the same vein as other consumer goods. Lumping medical care into the same category as a buying a car or houses strips away its essential difference from other services. The increased focus on the business of medicine serves to remove the actual impact on individuals and society.

Health care is expensive, especially in the United States, where often bloated administration, unrestricted drug costs, and fractured care systems push up costs. Patients are easily blindsided by bills for services they do not understand. Physicians are forced to walk a thin line between the most appropriate test/treatment and what an outside entity will pay for.

Value-based payment systems cloaked in a false claim of improving health care penalize physicians for the inability to achieve quality measures but fail to address the actual barriers patients face. How can physicians deal with poor disease management in patients who cannot afford medication or have no leeway to miss work for an appointment? Patients in front of me live in a food desert, while the cost of insulin is hijacked by greedy pharmaceutical companies and the wisdom of the insurance company is to reimburse less or not at all for missing an imaginary quality marker the outcomes that actually matter suffer.

Curing patients is not a sustainable business model which is why we must move away from a private health care model. It’s built-in inefficiencies and unabashed focus on profit have left this country with a declining life expectancy and other health outcomes expected of a third-world country.

Improved health benefits society. Healthy adults can work and contribute the economy. Healthy children can focus at school. In a culture that places high values on the individual, it can be difficult to propose a single, national health care system. Yet, as Walter Cronkite once mused: “America’s health care system is neither healthy, caring, nor a system.”

We can and must do better.

A Washington Post-Kaiser Family Foundation poll found that 51 percent of Americans support a single payer, Medicare for all system. Evidence from other countries with socialized medicine demonstrates that by providing essential health care to citizens without burdensome costs increases access and improves health outcomes. Every other industrialized nation has figured this out, the United States needs to get on board.

Certainly such a system requires substantial changes from our current, splintered system. Yet imagine the improvement. A streamlined individual medical record that allowed seamless communication between a patient’s family physician and a specialist could save money in reducing redundant blood tests and imaging. Medication errors could be reduced if all members of the health care team could see that another member had stopped or started a prescription. Patients who have moved would not need to wait weeks or months for prior offices to fax (yes, we are still faxing) medical records.

Beyond the potential safety benefits, a universal system that did not rely on individual, often insufficient, insurance could begin to breach the gap of care. Instead of seeking more expensive, emergent care once a condition has deteriorated, patients could receive appropriate preventive and early disease treatment. A single payer could have immense sway in negotiating with pharmaceutical companies as there would be few other avenues for sales.

Removing executives with an eye on profits in favor of physicians and clinicians focused on patient care will shift the emphasis from sustaining a business model to sustaining a healthy population. If I could spend my day truly providing patient instead of filling out absurd prior authorizations or being pressured to see more patients to make up for declining reimbursements, I could probably meet more of those quality measures. More importantly, with appropriate resources, I could have healthier patients.

This is, of course, just a starting step. Even if we are able to enact a true national health plan it only begins to address some of the larger problems. We need to continue to push for methods to fight poverty and the barriers to care that stem from being poor. Both insidious and overt racism within the medical care system must be fully acknowledged and overcome. Inclusion and diversity must be a guiding principle. In a country with the advanced capabilities and vast wealth of the United States, it is inexcusable that anyone here is denied the ability to live a healthy life. Business models are designed to include only those factors that fit the bottom line. What we need is a health care system that promotes health for everyone in a caring manner.