Like many others, I have a personal — and, yes, passionately felt — view of what health care delivery should look like. I’ve read much, and associated with medical professionals for a long time — and listened when they expressed thoughts and ideas — but mostly I know enough only to be dangerous, not necessarily right. I’ll cover as many details as I know to cover, the rest is up to you to ponder, question, challenge and suggest.
- Training: I see no reason to interfere with the evolving roles we see now. Nurses are finally getting formally recognized for their contributions, i.e. nurse practitioner credentials. Indeed, I want to see it progress further. In the meantime, curricula and training protocols should be examined for some sanity checks. There is strength in the notion that qualified candidates should be nurtured and supported, not saddled with enormous debt (pushing them to go for the rarified specialties with the best income potentials) and especially not tortured with slavery-like work weeks as interns and residents.
- Compensation: If a man or woman shows potential and commitment, and if they are not expected to foot the bill with egregious loans, compensation can be better designed for things like the regional cost of living, demand for their specialties and their preferred delivery environment, i.e. private/group practice, clinic, research or hospital.
- Cost of delivery: I believe that the current arrangements revolving around insurance are inadequate at best, damaging at worst. We can start with the example of the defense industries, who must balance between the desire for profits and the desire of the taxpaying public to not support a small group of wealthy investors. Defense, I submit, is a “single-payer” arrangement (sales to foreign governments notwithstanding) with aspects that work alongside the flaws. We could learn some good lessons from that. (And, maybe, drive some reforms in defense spending as well.)
- Professional integrity and patient trust: This is the one we see most-talked about in the negative. Death panels. Physicians cutting corners, ordering redundancies or using outright fraud to make more money. Insurance companies second-guessing diagnoses and treatments for the sake of better stockholder dividends. Physicians paying exorbitant malpractice insurance premiums, not to mention paying for lawyers to fight frivolous lawsuits. I don’t honestly know where to start, but again there is a model we might follow: the Bar Associations. Lawyers choose amongst themselves people to sit in objective judgment, both for initial qualifications (the exams) and later performance to ethical standards. For elected judges we have impeachment, for all judges we have removal from the bench. I find it difficult to believe that medical professionals — who have a very well-defined code of ethics — can’t be trusted and expected to “police” themselves effectively.
Those are the primary points as I see them. I firmly believe that profitmaking is at best detrimental and at worst criminally dangerous in health care delivery. If we really see a need to have competition as a constructive and/or progressive aspect in health care, we can do it in other ways. We can reward academic achievement during the training. We can institute a variation on the Nobel prizes for advances in medicine. We can give ER staff an extra two or three days off after a 90-hour week instead of making them work 100 hours the next week. And we can enjoy stories like one I like to tell, the neurosurgeon who sat me down to discuss the diagnosis and prognosis of my condition and started with “Mr. Evans”, smiling widely, “I am happy to inform you that you are a freak of nature.” That he had a 95% success rate for treating my condition almost became secondary, because I didn’t need to be wearing a hospital gown and occupying a bed with tubes stuck in me to appreciate his bedside manner, but mostly to see right away that here was a man who not only was very good at what he does, but really enjoyed doing it.