“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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The Future of Healthcare: One Doc's Opinion


So, looks like the healthcare bill is passing. (I am writing this on Sunday afternoon.)

My feelings are mixed about this. Over the years I have seen many cases of patients who have lost their health insurance and come to me in flat out panic. If applying for individual coverage, they have been denied due to their health history or even, in some cases, incredibly minor things. If the bill will solve their problems that is a good thing but I'm not so sure it will. Plus it comes with a lot of baggage, not least the fact that nobody knows WTF is contained in the bill. Congress now faces the challenge of thrashing this thing into shape after passage, since they had to rush it through sloppily to get it passed at all. Even Obama doesn't know what all is in the bill and what isn't: see this interview. This procedure makes about as much sense as a museum buying a chunk of marble and then hiring someone to sculpt the Venus de Milo out of it.

Also, as I mentioned previously, there aren't enough doctors/healthcare providers to provide care to all these newly insured patients who presumably are going to sign up. Check out this Newsweek article, which I think explains rather well what is going on. The process of finding a doctor is going to be like musical chairs: when the triumphant "We Passed Healthcare" music stops playing, a lot of potential patients are going to find themselves with no place to go. Though I will report one piece of cheering news. The number of students entering family practice residencies has picked up this year. Perhaps, in a recession, med students have finally figured out that if you go into primary care you will never lose your job.

Prices will be higher for insurance all the way around. Employers will either go out of business (if they're small) or fire part of their staff and insist that those who are still employed pay a higher share of the bill. Your taxes will go up, I guarantee it. National debt will also skyrocket. If we - the employed/insured - are willing to put up with this, then so be it.

Why do I say all this? Can the government provide good, basic healthcare for less money? They probably can. Unfortunately nobody wants basic healthcare. My definition of basic healthcare is the following: Infertility isn't covered. Viagra and similar drugs aren't covered. Organ transplants: may or may not be covered, but the antirejection drugs you'll need probably won't be. Breast reconstruction after mastectomy? Not covered. You get a beanbag to put in your bra. Seeing a dermatologist for acne: not covered, your primary care doc can do that. And so forth. Most of this stuff won't shorten your lifespan if it is not covered, but my impression is the American public will be pretty pissed off to hear this.

The other issue is the iffy circumstances under which the bill was passed. A large portion of the population is against the bill, will remember who voted for it, will do their best to vote those who did out of office. Many states are preparing to sue the Federal government to fight the passage of the bill. They may well lose, but the money spent and the bitterness engendered will leave a lasting legacy.

The next few weeks are going to be a bumpy ride.

Labels: Medicine, Politics

posted by Dr. Alice at #