Sunday, August 02, 2009

Health Reform?

Certain catch phrases seem to be in-vogue. Last year it was 'bailouts'. Now, it's 'Health Reform'.
Pavlova asked me the other day what I thought of a government funded healthcare plan, and what I thought of Obama's proposals.
I guess I'm still undecided, frankly speaking. One reason being, although I should be more aware of what's going on, I haven't really kept up to date with the proposals he has.
In concept, a national healthcare plan sounds good. We eliminate the problem of the uninsured, or the underinsured. God knows this is a problem in this country- just last week alone I was lamenting to my nurse about how frustrating it is for my patients to not be able to afford their meds. I had 3 patients last week alone make a conscious decision to drop some medications just to 'stretch things'. As a doctor I felt helpless except to listen to their woes, and perhaps to offer them samples. And I know when I was running the free clinic back in MN, we never saw any lack of patients.
The problem with a centralized government funded plan, is how this would affect care for everyone else. Think about it; if as it is you sometimes have a waiting list to see a specialist or to have a procedure done, how would you feel if suddenly you double or triple your wait time, when suddenly everyone was in line?
People here always say, "If Canada could do it, why not the USA?".
Well, I remember Ben, a friend in medical school who needed knee surgery- he waited 3 months just to get the MRI scan because it was 'elective'. How would people feel about it? Also, many are concerned that if you are not concerned about paying for your care, would this lead to abuse of the system? Perhaps this is ungrounded, but I know we saw a version of this where I used to work- the employee health coverage was so good that people started going to the ER for coughs and colds, just because it was more convenient to do it rather than to take time off during office hours to see a physician in his office.
Furthermore, as a friend put it recently, just taking an objective step back and thinking about it: If someone who pays $100 a month for insurance and the other person doesn't, how can you expect to provide exactly the same level of service to both? Let's not talk about medical necessity, but about the other elective or nonurgent concerns; same type of hospital room? Same wait time for a consultation? Same access to imaging? How would such a system survive? Would you bankrupt the system giving the most excellent care to both groups? Or do you bring the level down enough to be financially viable and have the payers complain about having to share his room with 3 other patients?
Perhaps Obama's recent proposal for a two-tiered system may very well be a solution. I know we in Malaysia complain of a two-tiered system, but this may address some of the potential problems people anticipate. After all, Canada's federally funded system is not without it's problems. And while I have never worked in the UK, I've certainly heard plenty of complains about the NHS.
Honestly, I have no answers. I just know the system seems broken currently, and I do what I can to give good care to my patients.


Blogger pavlova said...

Well, I am not quite sure how the insurance system works in the US, but I have watched several docos, namely Sicko by Michael Moore to make me feel very sorry for the patients. Let's not talk about the 50mil Americans who aren't insured, even those who are insured can't get coverage.
A woman who is 22 yrs old and has ovarian cancer was denied treatment by her insurance policy because they only pay out to persons over 26.
She is $20,000 in debt over medical bills and now has to declare bankruptcy to pay for her treatment. Her husband and her have just lost insurance coverage because they've lost their jobs.
This might not be representative of the whole population, but the fact that this is happening isn't great.

For the other Commonwealth countries, we rely quite heavily on the public health system. In UK, NZ most people do not have health insurance. For those of us who do, we just buy it because we want to be on the top of the priority should we need a surgery.
But for those who don't, yes they are on the waiting list, but if it's something urgent, they will do their best to priorities the patient. An ex colleague of mine, whose partner's eyes are going blind because of a condition desperately needed surgery. But because they live in a provincial town, the hospital doesn't have the neccessary eye specialist there. So the hospital (public one too) flew both the patient and the partner out to a major city, flight, accomodation and taxi fares paid.
So I think a universal health care system is neccessary. It might cost a bit to overhaul the system, but surely we can't just not take care of the poorer segments of society and let them die...

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10:42 PM  

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