Who is responsible for the Health Care Mess?

CRO_health_affordableCareAct_05-14[1]I as a physician am. You are. The President and Congress are. Pharmaceutical companies are. Or, as President Trump was heard to say, “Health Care is a lot more complicated than I thought”. As someone who has been in the midst of health care for 30+ years and who has also seen better health care for fewer dollars in other parts of the world, I would like to share my thoughts as to how we can talk common sense and come up with a better solution than either ObamaCare or TrumpCare.

We first have to discuss whether health care is a human right or a privilege. As the richest country in the world and one with the largest economy, I would argue from a moral standpoint that access to basic health care is a right. Luke 12:48 was quoted to me by a judge when our family appeared in court to formally adopt our Korean daughter. “From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked.” The judge understood that our family was blessed with talents, wealth and knowledge and asked that we use these instruments in the community for a greater good. The same should be held true for America – we benefit from living in a country with numerous natural resources, a democratic government and public school system. Using great minds in our country, we should be able to implement a basic health care system that is available to all of our citizens. If we have a finite amount of money to spend in the budget, where should health care fall in the priority list? Currently 55% of the US budget is spent on the military and only 6% on healthcare for all US citizens. Are we ok with spending money to defend our country beyond US soil while back home our own citizens die or become sick due to preventable illness?


Now that you are well into the quagmire of the ethics of Health Care, lets turn to the players in the system. The current system of paying hospitals and physicians is backwards. Spending my time in the office doing procedures is much more lucrative than counseling patients on improved lifestyle and performing preventative care. I can deliver a baby by cesarean in 30 minutes during daylight hours and be paid almost twice as much as compared to managing a women in labor for 24 hours, spending all night in the hospital and getting up for a 4 am vaginal delivery. Treating a woman with heavy menses with either birth control pills or a Mirena IUD only generates an office visit charge vs. performing a hysterectomy that takes an hour and increases my payment 10x.   The ACA made an attempt to fix this by implementing quality care standards (such as lowering the cesarean rate) that if met, increased your paycheck from the government. Unfortunately, the cost of implementing and reporting those standards was often more costly than the payback. Physicians are human just like every other American – some of us will strive to provide the most cost-effective care for our patients while others will look out for only their bottom line.

US senators are currently tying themselves in knots trying to come up with a Health Care plan that satisfies both conservatives (any government health care is too much) vs. moderates (expand benefits to the needs of their specific state). I find it ironic that conservative states such as Ohio and West Virginia want more federal money for the  opioid epidemic that has devastated their health care budget but yet these are some of the same states where the citizens and government officials are working to defund  Planned Parenthood. Having seen the astronomical costs both emotionally and economically when babies are born to drug addicted mothers, common sense would be to provide free or reduced cost birth control in those impoverished areas where opioid addition has taken hold. Each government representative is doing what is best for their state and citizens and not one of them has been willing to stand up and declare what is best for the country as a whole. If they really cared about America they would put aside political divides and approach this as adults, not toddlers trying to protect their pile of toys. Our President, as a former Democrat and now a Republican, should be working to bring these opposing sides together and Make American Great by being the champion of a health care policy for all Americans.

The price of prescription medications in this country are higher than anywhere in the world. And yet the pharmaceutical companies that develop and manufacture these same drugs are based in the US and use taxpayer dollars to fund the research and development of drugs. Drugs are sold to other developed nations for 30-40% less than what our own citizens are charged. These same countries have a universal health care system that negotiates drug prices with the manufactures, something the US lacks. The US lacks an impartial regulatory board that not only regulates the prices of drugs but also puts restrictions on the use of new and expensive medications. Regulation also needs to be instituted in regards to advertising of drugs, both to patients and to health care providers. When I started in practice 25 years ago, my clinic had a policy that drug reps weren’t allowed into physician offices to meet with us. We were also discouraged from receiving freebies such as dinner. At the time, I thought it was a bit overboard. Now I realize that this practice shaped my ability to fact check dubious claims made by well dressed pharm reps who were treating me to an expensive dinner. How is the average consumer able to decide between a generic inexpensive drug that has no public advertising and a drug that appears in a full-page color spread and is purported to drastically alter their life for the better?


And finally the American people are to blame for the health care mess. We want to have our pick of the candy store (health care) without regard to price or outcome and we don’t want to be held accountable for our personal decisions that drive up the cost of the candy store. 35% of Americans are overweight and 10% are morbidly obese, contributing to the skyrocketing incidence of hypertension, diabetes, joint and low back pain, heart disease, sleep apnea and endometrial cancer. But we continue to sit on the couch and eat unhealthy diets, all while complaining about the price of medications to control our illnesses. I discussed this very subject with a mid 50 woman this week. She smokes 1/2 a pack of cigarettes a day and is taking 4 medications related to the health effects of her smoking. We discussed  priorities regarding her health and how she spends her money in addition to options to improve her overall health. She has knee pain and doesn’t feel that she can walk or exercise. She is worried about the health effects of pesticides on food, so limits herself to one fruit or vegetable a day. The perceived level of stress in her life limits her ability to quit smoking. She enjoys the sun so spends summer weekends laying outside and visits tanning booths in the winter. After twenty minutes of this, I gave up trying to motivate her. And I was paid the same amount for a preventative care visit whether I had started this discussion or not.

Yes, it is much more complicated than anyone imagined. But not impossible. We don’t need to recreate the wheel, as many first world countries, such as Australia and Canada, have health care systems that not only work but also cost much less and have better outcomes. I think whether you call yourself conservative or liberal, we can agree that a health care system that costs less with better outcomes is a winner for all Americans.