Post 1.0 – Healthcare Reform: 10/23/10

This space will be mainly dedicated to discussing what appears to be important at a given moment in the worlds of Functional Neurosurgery, Spine Surgery, and Neuro-oncology. The bounds of conversation may occasionally be broadened a bit; we’ll play that by ear.  The frequency of the posts will be dictated by the degree to which there is something new and interesting to say, as well as the degree to which we have the time to type it. A two-way discourse would be ideal on some issues.  Please feel free to comment. In addition, please feel free to use this portion of the site to pose questions, as long as these questions do not involve urgent medical issues for which time-sensitive replies are required.

With mid-term elections approaching, and healthcare reform continuing to be a hotly debated issue, I can’t help but use this soapbox to make a few remarks. First, it seems that both patients and physicians are in for an extended period of uncertainty. Many questions remain about how the Healthcare Reform Act will be implemented, and whether portions of the law will need to be altered. Here are a few thoughts:

1)   While everyone in a civilized society should have access to basic healthcare,  the idea that everyone is entitled to the most advanced care available (e.g. a liver transplant) is not fiscally sound.

2)   Given #1), while rationing of healthcare is not politically (or, often, even ethically) palatable, it is a fact of life. To deny this is intellectually dishonest. A society may decide to ration healthcare based on eye color, age, financial net worth, IQ, etc. The rationing may or may not be explicit. However, if we decide to stop burying our heads in the sand, this should be acknowledged and discussed. A choice between continuing to ration and bringing everyone to the mean by eliminating expensive services altogether will have to be made. I doubt many will support the latter choice.

3)   The refrain of “Obama death squads will kill your sick grandmother” is senseless fear mongering. If one is to be serious about cutting healthcare costs (a large percentage of which is typically incurred in the last several months of life, and often buys no additional quality life), and one is to uphold the values individual self-determination and autonomy, then humane end-of-life care and a sensible “Right-to-die” policy must be discussed and implemented. No one should be coerced into ending their life any earlier than they wish. Decisions should always be made by the patient and his or her family. In my experience, most well-informed people choose not to extend their own or their their loved ones’ suffering when quality life is no longer possible.

4) There is much fraud, abuse, and inefficiency today in the healthcare industry; these must be rooted out.

5)   While the cost of delivery of healthcare in this country makes up an unsustainably high proportion of the GDP and therefore must be controlled, rapid technological innovations and the societal expectations that these  innovations are to be immediately applied to everyone make cost-cutting difficult to achieve. We want to have the latest technology when it comes to spinal implants, cancer chemotherapy, heart transplants, deep brain stimulators, joint replacements, AIDS medications, etc. Yet, we want to compare the costs of medical care today to that in the 1960’s or 1970’s, when these technologies and treatments were not available. Making the comparison, we are appalled by the rate of cost increases. This is really comparing “apples to oranges”. Something cannot be bought for nothing. Something has to give!

6) Recent trends toward the “corporate practice of medicine” and shift work will not improve the quality of care. They will make both patients and physicians more anonymous and the delivery of healthcare more impersonal. If this type of healthcare delivery system is mandated for the majority of the population in the name of cost-cutting, it will ultimately lead to a significant change in the type of person who chooses to become a physician, as well as in what we today define as a doctor-patient relationship.

Clearly, the above points contain competing ideas, and there are no easy answers.

Let’s see how the debate proceeds….


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