Curmudgeon's Corner

cur-mud-geon: anyone who hates hypocrisy and pretense and has the temerity to say so; anyone with the habit of pointing out unpleasant facts in an engaging and humorous manner

Three Health Care Flaws...

As we wend our way down the trail of national health care reform, we really ought to reform those areas that are the biggest causes of problems.  The blog, Health Care Policy and Marketplace, today had a thoughtful discussion that I felt needed to be shared in that it mentioned the three biggest flaws in our present system.

Obviously, President Obama will be in Green Bay touting national health care reform and making promises that will sound good to the most of us.  Unless "reform" encompasses these three flawed areas, there is little likelihood that reform will make much of a difference in the problem.  We'll still be paying way too much money for our health care, and we'll either go bankrupt as a nation as the result or suffer lesser healthcare than we ought to receive.

Flaw #1:

Our health care system has become one that is driven by specialty providers rather than by primary care providers.  There is a shortage of primary care doctors in virtually every state in the union, including here in Wisconsin.  There is no such shortage of specialists.  This results in greater long-term costs that might well have been mitigated if the primary care doctor had been able to intervene along the way by spending more face-time with each patient and by being more accessible in the first place.


We do not have an integrated information technology system across the nation.  We don't have such a network across Wisconsin.  We don't have such a network across Milwaukee.  That day is many years down the road in spite of what we're being led to believe.  This leads to barriers to cost transparency, excessive repeat testing and stymies the savings that could come from evidence-based medicine.

Flaw #3:

We live in a fee-for-service world that encourages more and more services be provided since that increases the reward for the health care provider.  It does nothing to promote payment based upon results.  If we had a results-oriented system of reimbursement, we could expect significant cost reductions and likely would see the same or improved outcomes.


The "reform" being discussed today is nothing more than throwing more money at the flawed system and hoping that things will get better while promising citizens that everyone will have coverage, etc. etc.

We need to remember that everyone has coverage today.  It is illegal for a hospital to turn a patient away without having provided necessary services.  We can expand coverage for those people without bankrupting the state or nation. 

We need to remember that the vast majority of people who do not have insurance coverage are in that group that doesn't want insurance coverage.  We can make coverage available to all but will need some way of forcing them into that coverage.  That can be done without bankrupting the state or the country. 

We must remember that each of us will suffer in the new health care system since there will be insufficient money to do everything for everybody.  When the money runs short, there is but one solution; slow down the provision of care so that funding can catch up.  When there is insufficient money, we'll attract fewer people into the health care disciplines and, therefore, fewer primary care physicians since there'll be little long-term monetary reward to offset the time and money put into the training.   This result need not occur if we handle the three flaws and wisely plan for the needs identified above.  All those who are part of the system will have to have "skin in the game" and that can be accomplished.

You can tell me I'm full of baloney if you choose, but you are ignoring the realities that exist if you do.  The problems are far more complex than we are being led to believe.  We deserve better, but that isn't likely to occur in today's environment.


The Curmudgeon Blog today is titled "Bad Idea Made Worse".

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