Tuesday, July 28, 2009

What Americans Want And Do Not Want In Their Medical Care

The Administration and Congress have established self-imposed deadlines for health-care reform. The major argument is that health-care reform is a mandate from the electorate. When the electorate was asked of we desire health-care reform, polls have convincingly demonstrated that the majority of Americans desire health-care reform. Who doesn’t want health-care reform? The problem is the following: Congress and the Administration have taken Am-ericans’ desire for reform as carte blanche to establish their version of healthcare reform. The question as to whether we want health-care reform is only the first step. The devil is always in the details.

Over the past few years, I have been asking my patients about their concerns regarding what they think should be included and excluded during considerations for improving health-care delivery in the United States. Below is a summary of their thoughts:

Americans desire the following in health-care reform:
• Affordable access to quality health-care for all – to include the uninsured, underinsured and those with pre-existing illnesses
• Adequate insurance coverage for health-care
• Competent physicians and other health-care providers
• Caring physicians and other health-care providers – health-care providers with a good bedside manner
• Choice of physician: primary care and specialty physicians [pending legislation to reduce Medicare/Medicaid reimbursements to support a government run health-care program will negatively impact Medicare and Medicaid patients in this regard]
• Choice of hospital
• Quality health-care close to home [pending legislation reduce Medicare/Medicaid reimbursements to support a government run health-care program will negatively impact Medicare and Medicaid patients in this regard]
• Research and programs for disease prevention – specifically, there appears to be quite a bit of interest in obesity and psychiatric disorders
• Improved coverage for psychiatric disorders – too often, inpatient services are cut short
• Improved end of life care
• Laws preventing private insurers from terminating coverage or drastically raising premiums on short notice
• Automatic health coverage, equivalent to previous coverage, for those who lose existing health insurance after losing their job or family member who carried the family insurance
• Health-care providers should be making medical decisions [corollary: neither insurance companies nor the Centers for Medicare and Medicaid Services should make such decisions]
Americans do not want the following:
• Delays in treatment – [Treatment delays are unacceptable when such delays would negatively influence survival (longevity), quality of life, or productivity {Scenario: A very healthy and previously active 54 year old woman, president and CEO of her manufacturing company, with painful arthritis of the hip must wait 6 months for hip replacement; this results in diminished productivity and quality of life because of limitations in mobility from the pain and requirement for strong pain medicines}].
• Rationing of health-care – [This is the elephant in the room topic; health-care rationing is unacceptable when such rationing would negatively impact survival, quality of life, or productivity {Scenario: A very healthy 73 year old woman previously very active in the community with painful arthritis of the hip is denied hip replacement because of age cut-off; this results in diminished quality of life, productivity and possibly survival}].
{This is not a “scare tactic” as some would suggest, but rather these scenarios are representative of some situations encountered in health-care systems in other countries by acquaintances or relatives of patients or colleagues of the author}.
• Denial of health-care for pre-existing disorders [citizens with pre-existing illnesses are the most in need of health-care coverage]

We’ve heard the often repeated argument that we have to do something and not do nothing. With the chance of doing something and getting it wrong? I think not. What is apparent is that the Administration and Congress have a deep rooted fear that there is a small window of opportunity to get health-care reform legislation passed, otherwise it’ll never happen. I think not. Congress and the Administration must be applauded for raising the issue of much needed health-care reform. Americans are bright and will not forget this issue; after all, health-care affects all of us, our loved ones and our financial solvency. So let’s take a deep breath and look into the details of what we as a nation want included in health-care reform. Let’s not rush to get something done for the sake of fulfilling a campaign promise. To get this wrong we run the risk of program failure while not delivering on the promise of health-care reform. Americans would prefer a well thought out plan for reform with all the above taken into account. Yes, health-care reform is an electoral mandate. It is not, however, an electoral mandate to get it wrong.

The issue of health-care reform is far too important to leave to Congress, the Administration and other policy makers. Rather, health-care reform, presented as a number of possible options, should be submitted after much discussion to the American electorate in the form of a national referendum. Then and only then can we say we got it right.

This article may be downloaded from my website:

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