Tuesday, August 11, 2009

An insider's perspective of health care reform

A good friend of mine is a pediatrician/activist/mother and she wrote an amazing letter regarding health care reform from an insider's perspective. I wanted to share it with everyone.

Peace & Blessings.

Krenie Stowe, M.D., J.D.
Health Education, Advocacy & Literacy, Inc.
www.healthedadlit. com / 713-201-6704

July 16th, 2009
Honorable Congressman Conyers,

The legislative approach to health care reform currently under consideration by both branches of Congress is fundamentally flawed. Health care cannot safely or ethically be considered a commodity. It must be understood as a human right.
If our homes catch fire and we call a fire department for assistance, are we asked if we have insurance or cash to cover the cost of extinguishing the fire? If we are robbed or assaulted and call the police, do they require payment before services are rendered? Of course not. Yet we accept this standard when it comes to the delivery of health care services.

For profit insurance carriers have an interest in money to shareholders. The function of such entities is to enrich those shareholders. This function must, by definition, undermine providing coverage to those who are ill. Insuring the sick is simply not profitable. No regulatory structure will change that underlying fact.

Currently, thanks to skyrocketing health care costs and the perpetually growing number of under and uninsured, there is energy focused on real health care reform. Astronomical costs tied to health benefits of employees and retirees contributed substantially to the collapse of the auto industry. Health care expenses are the leading cause of bankruptcy. The perfect storm is brewing.
The health care bill under consideration in the House is nothing more than a bail out. Perhaps the most glaring flaw is that after spending over $1.5 trillion, there will still be 17 million uninsured. But more troubling is the failure to address the administrative waste in the current patchwork system. The fabric of our current health care system is akin to a large, tattered quilt. The stuffing has leaked out. There are more holes than intact segments. Yet instead of accepting the inevitable, we grab another handful of scraps and try to stitch it back together. And we don't even notice who handed us the scraps!
The system cannot be repaired. It is in decline. The only viable options, if our agenda is a healthier population, are to euthanize it or to let it die. DO NOT RESUSCITATE.

If those in Congress squander the political and popular will that are building each day on a mediocre piece of legislation, the result will be a deeply flawed and expensive system that will be used as a political football in the election cycles that follow. Every policy maker on the right will revel in the brand new, costly, failing health care system that still leaves millions uninsured.

Single payer health care is the only way to realize significant administrative savings. That statement must stand alone.

I am a pediatrician with 25 years of experience in clinical medicine. For over a decade, I operated a grass roots, non-profit health care facility in rural counties outside Houston, TX. During that time, we cared for over 11,500 children and their often uninsured parents and grandparents. I was the sole clinician. We had a staff of six, myself included. Three of the six staff members, including our executive director, spent essentially all of their time negotiating third party payers. They spent hours filing claims, appealing denied claims, getting authorizations for treatment, attempting to obtain coverage for children whose insurance had been terminated. Those hearing the horror stories would often comment that Medicaid was the problem, but we had more difficulty collecting from private payers than from public ones; and the problems with Medicaid collections escalated significantly when managed care was enacted because we then had as many as eight different Medicaid plans (insurance companies) to negotiate. More than one third of our operating expenses were devoted to billing and collections. Overhead of that magnitude is simply not possible for small practices to absorb over the long haul. The result has been the virtual death of the solo practitioner and of the small group practice. Administrative costs are forcing the consolidation and centralization of medical practice. This hits primary care providers in under served and rural areas especially hard. And it is taking the heart and soul out of medicine.

Perhaps you do get what you pay for. Corporate, for-profit health care is necessarily the result of corporate, for-profit insurance companies orchestrating medical care. The notion that "government run health care" will put a public bureaucrat between patient and doctor is absurd; there is already a massive private bureaucrat standing in the way. Empathy and humanity are not terribly profitable. And time is money. So the one thing that folks really need from their doctors, time spent explaining or answering questions or just listening to concerns or fears, is definitely not available in a profit driven system.

One of the deep ironies is that truly competent clinicians, clinicians who take careful medical histories, do thorough physical exams and exercise sound medical judgment, cost less. They order fewer invasive and diagnostic tests, they use medication more prudently, they resort to hospitalization less frequently, and their patients have better medical outcomes. But the one thing that physicians and other medical practitioners do not get paid for is their time, and this, too, is a function of third party payers. That's why surgeons earn more than primary care providers. Invasive, tertiary care pays.

The final point that I must make relates to the culture of medicine. If the object of health care reform is to improve the health of the population, than the conversation needs to go far deeper than methods of payment. We currently have a cesarean section rate of about 33% in the U.S.; at least 10% of children are on psychotropic medication; many feel they need to see a doctor because they have a sore throat or a stomach ache; we have become a nation of drug addicts believing that all ills require a prescription. If we are all insured, the situation may be, in some sense, worse: a cesarean rate of 50%; 1/4 of all kids on Ritalin; everyone able to ingest as many drugs as the doctor orders because cost will be no object.

There are also troubling questions related to the "benefits package". What services will be covered under the new umbrella of health care? Will midwifery be included? Abortion? Psychotherapy? Circumcision? Will certain treatment be mandated, like vaccination?

The things that are driving illness; obesity, isolation, inactivity, environmental degradation; are not things that can be surgically or pharmacologically repaired.

I believe that we have an opportunity to reshape health care. It requires bold action. The progressives in Congress must stand their ground. At some point, compromise is just a euphemism for selling out.

There is no healing left in health care in this country. A system of payment alone, even a single payer system, will not change that.
I would be more than happy to come and meet with you, Congressman Conyers. I would like to help shape this debate and to shine a bright light on the propaganda being peddled by the opposition. Please let me know your thoughts.
In Unity,
Krenie Stowe, MD, JD

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