Unhealthy Systems

I was in college when Hillary Clinton was charged with overhauling the U.S. health care system.  My contention at the time is that the last people who should be impacting the decisions of doctors were lawyers.  I still feel this way.  (It was particularly galling to many that doctors were essentially shut out of the discussions.)  U.S. health care continues to be the very best in the world…to those who have access to it.  And the reality is that most people in this country, insured and uninsured alike, get good care.  That’s not an argument for the status quo; our health care costs are growing at an unsustainable rate and clearly need to be addressed.  The Clinton administration initially explored a “Canadian-style single payer system.”  Though there is much to like about our neighbors to the north, their health care system is not one of them.

The median wait time between a referral by a family doctor and an appointment with a specialist has increased to 8.3 weeks last year from 3.7 weeks in 1993, according to a recent study by The Fraser Institute, a conservative research group. Meanwhile the median wait between appointment with a specialist and treatment has increased to 9.4 weeks from 5.6 weeks over the same period.

Average wait times between referral by a family doctor and treatment range from 5.5 weeks for oncology to 40 weeks for orthopedic surgery, according to the study.

I can’t imagine that Americans would be willing to wait ten months to get a balky knee or torn rotator cuff surgically corrected.  In fact, the Canadians are having a hard time with it as well.  Their government is working to reduce these waiting periods, but a growing free market is trying to address the problem as well.  (For more on this, check out Clifford Krauss’s As Canada’s Slow-Motion Public Health System Falters, Private Medical Care Is Surging, which is where I pulled the information above.)

Unfortunately, the free market doesn’t always provide the best solution either.  A couple of weeks after reading Krauss’s article, I read a Times Op-Ed by Dr. Peter Salgo called The Doctor Will See You for Exactly Seven Minutes.  Salgo has observed first-hand how health care has turned into a business, and therefore patients into customers.  This phenomenon is no longer restricted to the confines of the hospital either.  Salgo writes, “Outpatients “consumed” health care “resources,” too. Publicly traded H.M.O.’s, for example, began restricting doctors to an average seven-minute “encounter” with each customer. This apparently kept shareholders happy. But it reduced the doctor-patient relationship to a financial concept in a business school term paper.”

The doctor-patient relationship is in many ways more intimate than a spousal relationship.  People tell their doctors things that they wouldn’t feel comfortable sharing with their husbands and wives.  Patients allow surgeons to do things to their bodies that require an unbelievably high level of trust.  The market — beholden to bottom lines — can’t necessarily account for this.  Salgo contends that patients can drive companies to care, that P&Ls can be affected by discontented patients. “We can and must reduce health care expenses. But we cannot do it at the expense of patients’ well-being. The doctor-patient relationship is critical to the integrity of the health care system. It is not disposable. Turning doctors into shopkeepers who regard patients as customers is unacceptable.”

Leave a Reply

Your email address will not be published. Required fields are marked *