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A System in Name Only

If health care is a basic fundamental right – and I believe it is – then we have to make it a fundamental service that’s available to everyone.  We’re fortunate in this nation to have some of the best elements of health care – exceptional and committed medical professionals, the latest technology, and  groundbreaking research – on the globe.  But what America has in place today is really not a system. Our “system” is made of many disparate parts that work and often act independently. And, a person’s health care experience varies drastically depending on where you are, when you need care, how you approach that care and what resources you or your family have.  It’s a different story for every entry you may make (or try to make) into the “system.”

We need to change the overall “system,” because it’s not working well for anyone today.  It’s not doing the right things by all patients.  It’s not doing the right things by all caregivers.  And it’s certainly not doing right by the individuals, businesses or organizations that are paying for it through their own dollars or through tax dollars (which are really still “our dollars”). It’s just not working and it truly needs to be addressed in a timely, complete and meaningful way.

There are more efficient and integrated ways to provide care that are not only smart economically, but they’re also smart from a quality and a safety perspective.  For example, I believe in a system where doctors, hospitals and all qualified providers are paid for how well we do our jobs – not just for “doing things.”

We have to recognize that we can’t control every outcome and we can’t cure every patient, but we can control whether or not we provide the best possible medical care.  And if the right clinical steps are taken in the right sequence, then the patient will have the best possible outcome.  That’s what we need to encourage through research, education, policy, payment, practice and individual and professional expectations.

Part of the solution is tied to how doctors and hospitals are paid.  If you make everyone’s pay contingent on doing the right things and a patient’s outcome, it will lead to better coordination between the people who are caring for that patient.  Everyone involved will have a stake in the quality and cost of the care.  This approach would cement the disparate parties of the health care (doctors, payors, hospitals, labs, imaging providers, etc.) to function as a cohesive system for the good of the patient and the health (both physical and financial) of our country.

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3 thoughts on “A System in Name Only

  1. “We’re fortunate in this nation to have some of the best elements of health care – exceptional and committed medical professionals, the latest technology, and groundbreaking research – on the globe.”

    Is it “fortunate” or a matter of cause and effect? If it isn’t a result of magic, why does America provide the vast majority of medical innovation and technology?

    Our “system” is made of many disparate parts that work and often act independently.

    There you go! I knew you had the answer in you!

    And, a person’s health care experience varies drastically depending on where you are, when you need care, how you approach that care and what resources you or your family have.

    I have the same feelings about dining out, houses, schools, books, dates…

    Choices… consequences…
    Liberty… responsibility…

    I won’t quote every piece of your post, but it seems to me the argument you’re making is that independently operated functions of the healthcare industry do not provide the best care for all people at all times. And furthermore, that “integrated ways” – via central planning – are the answers to creating a more unified system.

    I’d like to address this argument.

    Is the best medical care available to everyone in our current system? Sadly, it is not. Is the care available dependent on time / place / resources? Absolutely, it is. That’s not the question. The question is, can the best medical care be made available to everyone regardless of time / place / resources? The answer is, quite regrettably, no.

    Whatever fascinations might be out there about what socialized medicine is capable of, the simple fact remains that there is a limited amount of resources. Be it doctors, nurses, drugs, hospital beds, capital… there’s not enough of it to ensure that everyone has the best care available all the time, everywhere, no matter what.

    That’s why there’s rationing and waiting lines in socialized medical nations. There aren’t enough doctors to do all the surgeries need. There isn’t enough money to buy all the drugs demanded… There just isn’t enough to give everyone the best stuff in the world.

    But the best available is never the result of central planning, and every government plan in the history of the world ever will tell you that. In the best case scenario, results you get from socialized anything is the same treatment – not the best treatment – just the same treatment.

    Like healthcare, the way McDonald’s would do it. Sure, your colon is treated like the stale frozen hamburger patty, but at least that rich guy around the corner gets the same treatment as you do!

    But then you seem to get more confused:

    “Part of the solution is tied to how doctors and hospitals are paid. If you make everyone’s pay contingent on doing the right things and a patient’s outcome, it will lead to better coordination between the people who are caring for that patient. Everyone involved will have a stake in the quality and cost of the care.

    It reminds me of Friedman’s 4 ways to spend money:

    1) You spend your own money on yourself: where you’re concerned about the cost and the quality of the good or service.

    2) You spend your own money on someone else: where you’re concerned about the cost but not overly concerned about the quality.

    3) You spend someone else’s money on yourself: where you’re not concerned about the cost, but you are concerned about the quality.

    4) You spend someone else’s money on someone else: where you’re neither concerned for the cost or quality.

    How exactly is giving my money to someone else to turn around and spend on me going to increase the quality or decrease the cost of my healthcare? How does that work exactly? The bureaucrats are going to take an extra special interest in my healthcare because I’m just so lovable? They’re going to make sure that mean old evil nurse inserts my foley with that extra special touch?

    Wouldn’t I be more concerned than anyone else in this world for the amount of money I spend and the quality of the service I receive? If so, why not have a system where I’m in control of my money and can choose the quality of care I receive out of my dollar? Why not get the central planners out of the way so doctors and hospitals have to compete for my buck and offer me the best care at the lowest cost?

    And this stuff about everyone having a stake in the system? Come on, you can’t really believe that. Who doesn’t give a crap about the cost? Probably the people who don’t pay taxes.

    The bottom 50% of wage earners make 13% of the income but pay 3% of the taxes, roughly.

    Who doesn’t have a stake in the system? The people who don’t contribute to the system.

    In which system does everyone have a stake? I’ll give you a hint, it’s not socialism… that’s right, it’s capitalism – the free market. Get on board, it’s a much nicer ride!

  2. Jeff,
    I wish I could shake your hand!! Thanks Dr. Atkinson for posting his reply. We all have different views! I wish more people would see the whole picture, not just ‘get us a public option’. oh and hurry, we have to pass a bill soon!

  3. When greed washes over Americans cleansing and bankrupting many of us of what little expendable funds average Americans may have in Financial terrorism of insatiable and insane money vacuum of us targeted sick in the Wealth-Care, blank check, money laundering system then government not only should step in they must step in to protect us American wildebeests who aren’t moneyed, experienced, or time empowered enough to fight the moneyed and empowered medical mafia and their un-convicted criminal cohort billing departments with their voodoo billings for additional revenue enhancements.

    What is the first thing or near first thing you are asked at a medical facility – “What insurance do you have!” This should be a hint at what the foundation of the wealth-care system is REALLY about.

    The focal point in fixing the Wealth-Care System is to fix the blank check charges – all else will follow.

    1. The ‘price’ of all procedures/treatments and related must be publically known, publically displayed in medical offices and in Free brochures and in an appropriate website which can be searched by anyone for treatment pricing and comparison (you know – like in capitalism). The price must traceable in its generation, if any (other than abject greed). The price charged for people with insurance and those without insurance and the discount price (upper three to four times the actual charge to make it look good) to insurance companies.

    2. The ‘profits’ of treatments, must have traceability back to its origin, must be publically known and displayed. The Greed level determined and then above a reasonable determined, international level be taxed at 200% or more at each at each level (or public whippings better).

    3. Whom the profits are distributed to and how much, at each level, must be known and shown.

    4. Medical billing is culpable as part of the medical mafia. All bills should show, ‘exactly’, what the cost of the procedure is and what people are being billed for, not nebulous – ‘surgical procedure’ or ‘treatment’ and hiding unverifiable enrichments. When bills are shown hidden or unjustifiable charges the billing company should be fined the cost of the magic treatments and the person who made and approved it should be publically known. The $3.00 aspirin (from 10 years ago) BS should be penalized back to the manager of the billing department from their paycheck.

    5. For those in the treasure chest medical system; insurance companies should not approve, shun and make public medical vampires charges that are unconscionable. Insurance companies should get together in an organization and compare the financial terrorists charges and profits and have those generating them shunned from insurance approvals and make public the charges of these financial terrorists.
    Warranty – instead of blank check, no responsibility voodoo treatments, win win for doctors and their enhancement of revenue who will ‘recommend’ anything whether it will really work or not. When a doctor’s procedure does not work or makes a situation worse – no pay or pay only exact provable costs – NO profit. I had one of these and two friends had voodoo treatments. Why isn’t this discussed in the flooding of medical moneyed propaganda! Doing something about the ‘no warranty’ plunder may make the medical vampires not so easily, off the cuff, revenue enhance themselves (as much), suggest voodoo treatments if they will not or may not work (they buy medical machinery they must pay for, for treatments that don’t necessarily work!).

    At last count 48% of Americans do not have health care. The moneyed do not mention this that I recall; I wonder why – no money in it??

    A person out of work will have trouble feeding themselves and if they have family feeding them (not just paying their mortgage and other bills) how are they to afford a financial terror medical treatment (or sustaining their medical insurance they previously had or affording new insurance) if a child is sick or injured! The medical moneyed seem to imply these are not good people since they are not able to enhance their enrichment! Of course these people you don’t hear being questioned about their situation and how they feel about living on the edge of a financial cliff that will destroy them and their families if they need medical help.

    Where are the stories of the financially victimized! Where are the stories of those charged hundreds of thousands of dollars for money-care treatments, ‘Studiously Misdirected’; Like me (one of thousands that could be brought into this picture) being responsible for $90,000 for a day and a half stay in a hospital and having a defibrillator (battery operated and wireless computer) stuck in me (which I am not totally convinced was needed) that cost $5,000 more than my 5 acre land and house cost in northern California. This kind of unconscionable financial insanity needs to be brought and kept in the forefront of discussions regarding the medical mafia and their dogmatic propaganda machine spewing misdirection and orchestrated slanted excuses they attempt to brainwash the Wildebeests with. Make a case for my situation I will find justifiable all way around please! Undoubtedly there are MILLONS of Americans over the past couple of decades that will have similar financial bloodthirsty medical events occur in their lives.

    Any Wealth-Care reform that doesn’t address and rectify the financial insanity Americans have been made inured to by time and insurance companies paying keeps pouring blood over the heads of the already blood soaked medical vampires – the same thing as the no-warranty treatment – the financial blood suckers keep getting their enrichment in blood reward; keeps rewarding them for their financial terrorism and keeps encouraging them to continue the financial, rape, pillaging, plunder of sick Americans at its fevered pitch.

    ‘People are more important than money’

    Until Americans shake their heads enough to empty it of their moneyed medical vampire programming money will remain more important than people.

    ‘Peopleism not capitalism’

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