By Peter Ewing
How, and for whom, should we provide health care in our country? After 45 years of medical practice in a variety of settings, rural and urban, office and hospital, fee for service and at our VA, I offer this perspective.
First, I offer two anecdotes from my own experience. Many years ago, a mother looking at the prescription I had written for her child’s cold, said “No that won’t do. Dr. Grace (in the neighboring town) gave him that this morning and he’s still not better.” Both doctor visits and both prescriptions were paid by Medicaid. What a waste of public money.
Two years later in a rural ER I saw a 30-year-old man complaining he just felt terrible for a while. My initial exam showed only that he was pale, so we sent some blood work. While awaiting the results he suddenly suffered cardiac arrest and could not be resuscitated. His test results subsequently showed only that he was profoundly anemic. Talking to his family we learned that he had been feeling poorly for a few months. He was between jobs and waiting for health insurance so he could see a doctor. I don’t know what his underlying problem was, but I have no doubt that, had we seen him a week earlier, he could have been diagnosed and treated. What a waste.
One story suggests that public funding for medical care causes wasteful abuse. The second shows another waste when we don’t provide access to care. Which is the bigger loss?
Recent news reports again show that Americans pay much more for health care, compared to other modern countries, with less overall benefit. Currently the finger is pointed at physicians’, and particularly at specialists’, over utilization of and high fee schedules for their services. Past reports have blamed insurance companies, pharmaceutical companies, fraud and abuse.
Americans have, generally, accepted the idea that no one should lack needed medical care for lack of ability to pay. We also have a firm conviction that “socialized medicine” is an evil concept, and we are firmly committed to the “free market, free enterprise” approach. It is quite appropriately inherent in the free market approach that every part of the system seeks to maximize its own profitability. Should we be surprised that doctors, both primary care and specialist, as well as drug companies, pharmacies, medical device makers and suppliers, various providers such as physical therapy, home care services, ambulance service, etc., legitimately charge as much as they can, and aim to maximize use of their most profitable, rather than necessarily most useful, lines of business? What business would do otherwise? And should we be surprised that unscrupulous individuals push beyond legitimacy with varying degrees of fraud for personal gain?
Achieving the goal of universal access to needed medical care is, by its very nature, socialized medicine. Trying to force this into the free market straight jacket produces our current wasteful and underproductive result.
Peter Ewing. M.D., is an internist. He lives in Lake View.