First and foremost, I am no economist. Nor a statistician, nor I know anything about Hospital Management. I am, above all, a primary care giver, a Periodontist. I will not give Big Data numbers or statistics, as any one of those can easily be skewed in favor of their ideals. This is my personal opinion on how healthcare should and could work for all. And as all ideas, it is not perfect.
We spend much of our time worrying about health insurance coverage. The first thing we wonder about a new job is the health insurance, and wen we lose that job, we wonder how long before we run out of that insurance and get a new one. A lot has been said about our current health system. A lot has also been said about “Single Payer Systems” (SPS) and “Socialised Medicine”. Even though I do not think SPS is a good idea, I also think that idea has no place in the United States. Why? Because the US is not Canada, Japan, England, or any other country you might think of. It is the third largest country by land mass and population. A SPS or Socialised medicine to cover all those people is a daunting task. It is, however, in the best interest of the US to ensure its people stay healthy and don’t go bankrupt just for getting sick. Medicine costs money. Research costs money. And as we “up” our “Healthy Living Years”, costs will keep rising. We think and hope technology will make medicine cheaper, but in reality it will make it more expensive. More accessible, yes, but costlier.
We should look to a combination of factors, a “Socio-capitalist” system if you will, that focuses on prevention as well as patient responsibility. We always tell our patients that prevention is the key to healthy living. THIS is where the “Socialist” part comes into play. As it is in the best interest of the US to keep its citizens healthy and productive, the government should cover preventive care and treatments in all stages of life. When I say preventive, I mean:
Medical: Physical exams every 1-2-3 years depending on age, Labs Checkups VACCINES (dealbraker if you do not want to vaccinate) and mammograms/prostate exam/colonoscopy for older patients.
Dental: Exams, Cleanings, Sealants.
As the US is too big a nation for a federal agency to cover all, giving the Individual States the task of “how” best to manage this system in order to make it work should be considered. The federal government would just ensure that all citizens have adequate preventive care. For the “Capitalist” part, this would allow for insurance companies to offer more extensive coverage options at a fraction of the cost as they will no longer need to worry about paying for regular exams, or pre-authorisations, while also minimising denial of claims. Initial Diagnoses would be done by the patients primary physician (be it specialist or generalist) and should they find something during a preventive routine care, the patient’s insurance THEN would come in to aid the patient.
We also need to ensure that for every $1.00 a patient invests in his insurance, $0.95 is spent on his health. This is where Big Data and Tech might come in. Patients could have control over their health history, allowing access by any doctor, hospital, or care facility. Just as .csv files can be read by any address application, or .pdf be read by any system, a universal Health Archive format could be created that can be read by, or exported, by any of the different individual EHR systems currently on the market. Insurance companies wouldn’t need excessive employees to manage the insured, but we do need to make sure that there is accessibility everywhere in the nation, just as there is internet data availability.
With the government providing preventive care, any complementary insurance that we obtain (if we choose) should be cheaper as it will not be used as often. When the time comes that we DO need our insurance, that money should have generated substancial gains to the insurance company to cover whatever coverage the patient might have obtained. Patients with familial history of cancer in their genes might prefer a coverage with increased Cancer benefits than heart conditions (for example). The “Capitalist Greed” however needs to stop. I’ve nothing against a fashion designer charging or earning millions of dollars for an article of clothing. Clothing is not essential for life. But when an insurance CEO earns upwards of $10million a year, plus benefits, plus private jets, all the while patients are being denied claims SHOULD, AND MUST STOP.
We also need to invest in the future. As a nation we are getting older (evidenced by the diminished number of children per couple). A hard campaign towards healthy eating and prevention is important. We cannot force people to buy insurance, but we can educate and encourage. Patients would then be responsible if they choose NOT to buy additional insurance. This is why focusing our attention to the children on prevention is the single most important factor towards improving the overall health in the US.
And last but not least, our focus should be on SOUND SCIENTIFIC BASED MEDICINE. Yes, we make mistakes and we do not know everything. I don’t think we will ever know everything, but mistakes and sacrifices are part of the learning processes. We now now more about diseases than ever before and we are much more successful in treating them. No self respecting scientist uses techniques more than 50 years old. Even now, once we graduate many of the things we learn become passé.
As the leading authority on medical care, we need to teach and educate our patients. Encourage vaccinations, preventive care and awareness, and ignore the fads that appear out of fear and misunderstanding.