American health care system

“Today's edition of of the American Psychiatric Association's *Psychiatric
News* (vol. 40, #14, July 15) includes an article by the American
Psychiatric Association president Steve Sharfstein: "Every Psychiatrist
Needs To Be an Advocate" (page 3).

Here's the article:

For more than 30 years, I have happily paid my APA dues. My membership in
the national APA and my local district branch has been part of my identity
as a psychiatrist and my commitment to professional standards and ethics
that transcend economic self-interest. It is one way of giving back. I
believe my membership in APA has served as a means to express my views in
the political marketplace and to develop an advocacy agenda that puts my
patients and access to quality care first. Now, as president of this
wonderful organization, I plan to make advocacy the central theme of my year
in office.

The Oxford English Dictionary states that "to advocate is to publicly
defend, maintain, recommend, stand up for, or raise one's voice on behalf of
a proposal...." As psychiatric physicians, I believe we are the natural
advocates for our patients because of our special, hard-earned knowledge and
expertise and our sacrifice and commitment to putting patients first.
Medicine needs a strong APA today more than ever.

The American health care system is in crisis. Americans are the least
satisfied health care consumers in the English-speaking world. Despite the
fact that we spend more than any other country on health care (approaching
15 percent of the gross domestic product), we are doing worse. According to
the World Health Organization, life expectancy in the United States measured
in healthy years ranks 29th in the world, between that of Slovenia and
Portugal. With the number of uninsured Americans now at 45 million and
growing, and the number of underinsured at many millions more, especially
for mental health care, one can see the dimensions of the crisis that led
President Bush's New Freedom Commission on Mental Health to declare "the
mental health system is in shambles."

Since 1980 American health care has radically changed. Before then we were
a system that was largely not for profit, driven by the doctor-patient
relationship and in the public interest. Over the last quarter century, we
have succumbed to market-driven strategies‹for-profit, corporatized, managed
health care. Publicly held corporations accountable to Wall Street and
stockholders ration care in America where the for-profit health maintenance
organizations (or managed behavioral health care companies) decide who
receives care, how much care one can receive, whether one can see a
specialist, how long one stays in the hospital, how many therapy sessions
one receives, and what medications one may take‹and these decisions apply to
the lucky individuals, those with health insurance. Those without insurance
are out luck.

We have the world's largest, costliest health care bureaucracies, estimated
to cost in the tens of billions of dollars. There is colossal administrative
waste in our system today, which includes countless hours spent by the
average American health care consumer on the telephone correcting billing
mistakes, arranging medical appointments, obtaining tests, and getting
referrals. It also includes the time and expense of dozens of billing
specialists at hospitals and doctors' offices trying to collect from the
more than 1,000 insurance plans that people have and hope will actually
cover their expenses, not to mention the hours spent on the phone or filling
out forms justifying "medical necessity."

There is basic anxiety among Americans about access to health care. If they
have health insurance, they worry they will lose it. If they don't have
health insurance, they know they are close to financial ruin. The most
common cause of personal bankruptcy in America today is medical expenses.

APA's agenda for advocacy must be to fight for the integrity of the medical
system and the public health. Advocating for universal access to health care
and parity of benefits along with utilization-review methods for psychiatric
and other medical conditions is not only just, it is a moral imperative that
also makes sense clinically and financially.

At the national level, APA has one of the finest government relations teams
among medical specialty organizations, but APA's advocacy also depends on
our district branches as more and more health decisions are made in state
capitals, and that means we need you, as individual physicians and members,
to step out of your office and get into the political arena for the good of
our patients and our profession.”

“Interesting article. There are a number of statements that beg for definition / clarification though, and some that are just individual opinion, not fact.

1. "The American health care system is in crisis".

"Crisis" is (arguably) the most over-used hype-word in our language. The system is in transition, not crisis. A crisis would be some catastophic event that would prevent people from getting needed healthcare, and that's not the situation.

2. Despite the fact that we spend more than any other country on health care (approaching
15 percent of the gross domestic product), we are doing worse. According to the World Health Organization, life expectancy in the United States measured in healthy years ranks 29th in the world, between that of Slovenia and Portugal."

Let's all remember that statement... the solution obviously isn't just money, but perhaps we should look at other criteria. The American culture of sitting on your backside watching the tube instead of exercising; eating out frequently at fast fat (excuse me, I mean Fast Food) restaurants, succumbing to the pharmaceutical industry advertising their drugs & convincing us we need all those pills to cure all our ills, and then DEMANDING that our doc prescribe them, etc., all are huge contributors to our problems.

3. "the number of uninsured Americans now at 45 million and growing".

What no one seems to want to talk about is how many of those 45 m have CHOSEN not to participate because they would rather spend their $$ on something else. The largest group here are younger males, many who, as we all know, believe they are invulnerable and don't need insurance... in their mind they need more beer or a faster car, etc. - higher priorities for them!

4. "the for-profit health maintenance
organizations (or managed behavioral health care companies) decide who receives care, how much care one can receive, whether one can see a specialist, how long one stays in the hospital, how many therapy sessions one receives, and what medications one may take"

This is called using the knowledge we've gained from "outcomes analysis" and applying "Decision Support" criteria so that all patients having the same diagnosis are treated in the same way, given the same meds, etc. We hold down costs by learning from what works and applying that to new situations. We HAVE to do something to control costs, and we SHOULD be in a system that rewards positive outcomes, not one where the more meds a doc prescribes, or the more procedures he performs, then the more $$ he makes!

Responding to all his points is the equivalent of an all-day seminar. A big part of the solution is computerizing healthcare & following the suggestions of everyone from Hilliary Clinton to George Bush for such an Electroniuc Healthcare Records system. Read the Intitute of Medicine study & you'll learn that your biggest concern should be having to go to the hospital... the medical community kills anywhere from 44,000 to 98,000 people a year throiugh medical errors. This is incontrovertible FACT, boys & girls, not opinion, and no-one diagrees with the IOM analysis. The only debate is who is supposed to pay for the technology.”

“It would be nice to have a counterproposal to the status quo from the author. As it is written, it sounds as if he's just sort of yearning for yesteryear.

Perhaps what's really needed is a new business paradigm that allows HMO's to reduce administrative costs by all but allieviating the claims and editing processes. A more simplified approach to healthcare that allows individual doctors to make medical decisions for their patients without insurance interference except in cases of fraud or malpractice seems like it would increase the satisfaction of HMO members greatly.

It seems to me like a national HMO has an opportunity to create a larger market share by taking a lesser profit per member in order to drastically increase quality and attract a larger membership - but in today's quarterly-scrutinized profit environment, it might just be an impossibility to undertake such a long-range plan.”

“It's Bush's fault. I don't know how but it just is.


























LOL!”

“I think we DRAMATICALLY need a new business paradigm. Unfortunately, one of the things holding it back are the M.D.'s themselves, who (like all humans) are very concerned about "change". They (justifiably) don't know how any such system would affect them financially, so they resist it. We met just yesterday with a physician in Sac to discuss an EHR application, but he "didn't want to fill out certain info on his patient" and therefore resisted the new tool which he admitted would have benefitted him (and his patients) in so many other ways. The kicker to all this was that the hospital system that recruited him to practice here was going to PAY COMPLETELY for his technology! He was simply afraid of them having info on how he treated his patients!

Sorry, but that just shouldn't be allowed. In nearly every other profession, we have mechanisms to determine how well one does their job... but too many doc's resist documenting treatments & outcomes appropriately.
last edited: 7/15/05 10:26:06 AM”