Neonanocyborgasm
Deity
- Joined
- Apr 21, 2004
- Messages
- 4,695
There have been many threads on CFC about the healthcare crisis in the US, but little in the way of any straightforward solutions. Most people posting are "civilians" and have only casual understanding of the problem. What you have all seen is just the tip of the iceberg, as far as I'm concerned, when it comes to American medical care delivery.
As a doctor, I'm in a unique position to see the inherent problems in the system, which I have been observing for some time. My opinions are not necessarily shared by all doctors, but I think I have a better perspective than most. My career has been difficult from the start. In a subculture of aristocratic legacy, I do not come from a family of doctors. I did not attend a world-class medical school or receive post-graduate training in the finest academic hospital. This has forced me to settle for lesser positions where I can observe problems. I have not had a comfortable existence in this profession so I can see how it is deficient.
Below is a summary of what I think are the salient problems.
I.
The first problem is one that everyone is most aware of -- the scarcity of medical care due to lack of adequate insurance. In the US, unlike nearly all other developed nations, medical care is not an entitlement. The exceptions include Medicare, which is available for the elderly, and Medicaid, which is available to the poor. This leaves the overwhelming majority of the population, who stand to benefit the most by preventive care, to fend for themselves. They must obtain medical care either by paying out of their pocket, or by buying private medical insurance. All of these are prohibitively expensive for a large fraction of the population. Even Medicare and Medicaid do not adequately reimburse, as those departments are not run by doctors but bureaucrats who know nothing of medicine. What tends to happen is that most people forego preventive medical care, even if they are insured, because the cost is prohibitive. This leaves them at the mercy of chronic diseases later in life, where they drain the government's treasury from Medicare. Even though the US spends the most on medical care, it has the worst morbidity and mortality statistics of all developed nations. In my opinion, the only way to solve this problem is to have universal health insurance, where all who pay taxes are entitled to it, just as it is done in most developed nations. People will no longer avoid doctor visits for preventive care because of the expense, and this will amount to reducing overall healthcare expenditure.
II.
A second and unseen problem is the tendency by the American medical establishment to allow sloppy medical care to continue without scrutiny. One often hears of malpractice lawsuits with large verdicts, but this does not appear to have had any impact, as they continue. Part of the reason for this is that there is a greater temptation by patients to sue the doctor, and gain monetary compensation, than to appeal to the State medical board for discipline. In addition, the state medical boards, like the medical establishment, have a culture of avoiding disreputing their own. Once a candidate enters medical school, it is virtually impossible to leave it, because the school will do everything in its power to make sure he finishes it. Most medical schools tend to inflate grades. This is all to foster an image of excellence. As a result, there is a large population of bad doctors circulating who continue practicing, because everyone insulates them. Time and again I see sloppy or inept physicians who go on doing more harm to patients without consequence. This will continue so long as doctors realize that there is no oversight to their actions.
III.
Third is the pervasiveness of greed and the vested interests of those who appeal to greed in American medical care, such as pharmaceutical corporations, insurance companies, and medical device manufacturers. These are the entities most responsible for delaying universal medical care in the US. As long as medical care is privatized, they can continue to charge exhorbitant fees for their products and services. They recognize that the more people are given choice to opt for a government sponsored program, the less they will have a market for their expensive goods. They go to great lengths to send lobbyists to Washington, and who try to convince the public to act against their own self-interests. They use arguments that try to scare the average person into believing that they will lose control over their medical care, as if they ever had much control to begin with.
As a doctor, I'm in a unique position to see the inherent problems in the system, which I have been observing for some time. My opinions are not necessarily shared by all doctors, but I think I have a better perspective than most. My career has been difficult from the start. In a subculture of aristocratic legacy, I do not come from a family of doctors. I did not attend a world-class medical school or receive post-graduate training in the finest academic hospital. This has forced me to settle for lesser positions where I can observe problems. I have not had a comfortable existence in this profession so I can see how it is deficient.
Below is a summary of what I think are the salient problems.
I.
The first problem is one that everyone is most aware of -- the scarcity of medical care due to lack of adequate insurance. In the US, unlike nearly all other developed nations, medical care is not an entitlement. The exceptions include Medicare, which is available for the elderly, and Medicaid, which is available to the poor. This leaves the overwhelming majority of the population, who stand to benefit the most by preventive care, to fend for themselves. They must obtain medical care either by paying out of their pocket, or by buying private medical insurance. All of these are prohibitively expensive for a large fraction of the population. Even Medicare and Medicaid do not adequately reimburse, as those departments are not run by doctors but bureaucrats who know nothing of medicine. What tends to happen is that most people forego preventive medical care, even if they are insured, because the cost is prohibitive. This leaves them at the mercy of chronic diseases later in life, where they drain the government's treasury from Medicare. Even though the US spends the most on medical care, it has the worst morbidity and mortality statistics of all developed nations. In my opinion, the only way to solve this problem is to have universal health insurance, where all who pay taxes are entitled to it, just as it is done in most developed nations. People will no longer avoid doctor visits for preventive care because of the expense, and this will amount to reducing overall healthcare expenditure.
II.
A second and unseen problem is the tendency by the American medical establishment to allow sloppy medical care to continue without scrutiny. One often hears of malpractice lawsuits with large verdicts, but this does not appear to have had any impact, as they continue. Part of the reason for this is that there is a greater temptation by patients to sue the doctor, and gain monetary compensation, than to appeal to the State medical board for discipline. In addition, the state medical boards, like the medical establishment, have a culture of avoiding disreputing their own. Once a candidate enters medical school, it is virtually impossible to leave it, because the school will do everything in its power to make sure he finishes it. Most medical schools tend to inflate grades. This is all to foster an image of excellence. As a result, there is a large population of bad doctors circulating who continue practicing, because everyone insulates them. Time and again I see sloppy or inept physicians who go on doing more harm to patients without consequence. This will continue so long as doctors realize that there is no oversight to their actions.
III.
Third is the pervasiveness of greed and the vested interests of those who appeal to greed in American medical care, such as pharmaceutical corporations, insurance companies, and medical device manufacturers. These are the entities most responsible for delaying universal medical care in the US. As long as medical care is privatized, they can continue to charge exhorbitant fees for their products and services. They recognize that the more people are given choice to opt for a government sponsored program, the less they will have a market for their expensive goods. They go to great lengths to send lobbyists to Washington, and who try to convince the public to act against their own self-interests. They use arguments that try to scare the average person into believing that they will lose control over their medical care, as if they ever had much control to begin with.