Wednesday, April 22, 2009

Differences between Health Care and Medical Care

I have a confession to make. I am schizophrenic about the health system as distinguished from the medical system.

On the left hand, I feel everybody ought to be covered and health care should bankrupt no one. On the right hand, I don’t feel government should impose these things. I believe government stifles innovation, imposes irrational regulations, limits choice, and drives doctors out of the profession.

In my most recent book, Obama, Health Reform, and Primary Care Shortages: Gloom for Improvement, Glimmers of Hope, now in production at the publishers, I have this passage near the end of the preface,

Difference between Physicians and Reformers

"As you read this book, keep in mind the fundamental differences between physicians and those who would fundamentally reform the system.

• Physicians are trained to treat and to cure disease and to alleviate pain. That’s what they’re paid to do, and from experience, they know it’s hard to persuade patients change unhealthy lifestyles once they leave the office or the hospital. Controlling in-patient and in-office care is one thing; controlling out- of -hospital and out –of-office behaviors are quite another. That’s one reason doctors are reluctant to be judged by outcomes when they know full well that many patients don’t comply with orders or change old habits. Some things are simply beyond the reach of the health system.

• Policymakers, on the other hand, tend to think that prevention should automatically be part of the physicians’ “toolbox, “and that care should be coordinated across the entire health spectrum from womb to tomb, inside and outside hospitals or offices, but physicians shouldn’t necessarily expect to be paid for time spent in discussing prevention or in coordinating or offering comprehensive care outside their realm. It’s part of their work. It goes with the territory.

Policy people often talk of converting our “sickness system” to a “wellness system.” Trouble is, people tend not to go to doctors when they’re well, but when they’re sick.”

This passage cuts to the heart of the issue, viz, health care as perceived by reformers is not the same as medical care as perceived by physicians. But I haven't point out these differences as cogently as Thomas Sowell, the distinguished conservative commentator who had this to say about issue in April 19, 2009 Real Clear Politics.

Words Versus Realities

Thomas Sowell

Much as I hate to be the bearer of bad news, I must report the shocking facts: Medical care is medical care. Nothing more and nothing less.

This may not seem like a breakthrough on the frontiers of knowledge. But it completely contradicts what is being said by many of those who are urging "universal health care" because so many Americans lack health insurance.

Insurance is not medical care. Indeed, health care is not the same as medical care. Countries with universal health care do not have more or better medical care.

The bottom line is medical care. But the rhetoric and the talking points are about insurance. Many people who could afford health insurance do not choose to have it because they know that medical care will be available at the nearest emergency room, whether they have insurance or not.

This is especially true for young people, who do not anticipate long-term medical problems and who can always get a broken leg or an allergy attack taken care of at an emergency room -- and spend their money on a more upscale lifestyle.

This may not be a wise decision but it is their decision, and there is no reason why other people should lose the right to make decisions for themselves because some people make questionable decisions.

If you don't think government bureaucrats can make questionable decisions, then you haven't dealt with many government bureaucrats.

It is one thing to deal with bureaucrats when you are at the Department of Motor Vehicles and in good health. It is something else when you have to deal with bureaucrats when you are lying on a gurney and bleeding or are doubled over in pain on a hospital bed.

People who believe in "universal health care" show remarkably little interest -- usually none -- in finding out what that phrase turns out to mean in practice, in those countries where it already exists, such as Britain, Sweden or Canada.

For one thing, "universal health care" in these countries means months of waiting for surgery that American get in a matter of weeks or even days.

In these and other countries, it means having only a fraction as many MRIs and other high-tech medical devices available per person as in the United States.

In Sweden, it means not only having bureaucrats deciding what medicines the government will and will not pay for, but even preventing you from buying the more expensive medicine for yourself with your own money. That would violate the "equality" that is the magic mantra.

Those who think in terms of talking points, instead of trying to understand realities, make much of the fact that some countries with government-controlled medical care have longer life expectancies than that in the United States.

That is where the difference between health care and medical care comes in. Medical care is what doctors can do for you. Health care includes what you do for yourself --such as diet, exercise and lifestyle.

If a doctor arrives on the scene to find you wiped out by a drug overdose or shot through the heart by some of your rougher companions, there may not be much that he can do except sign the death certificate.

Even for things that take longer to do you in -- obesity, alcohol, cholesterol, tobacco -- doctors can tell you what to do or not do, but whether you follow their advice or not is what determines the outcome.

Americans tend to be more obese, consume more drugs and have more homicides. None of that is going to change with "universal health care" because it isn't health care. It is medical care.

When it comes to things where medical care itself makes the biggest difference -- cancer survival rates, for example -- Americans do much better than people in most other countries.

No one who compares medical care in this country with medical care in other countries is likely to want to switch. But those who cannot be bothered with the facts may help destroy the best medical care in the world by falling for political rhetoric.


Terence Coughlin said...

Interesting points here. I think that there are a multitude of "schizophrenics" when it comes to what side of universal health care one comes down on. I know I fit this classification as well.

On one hand, who can argue that tens of millions of uninsured in the US is a tragedy, until you consider that millions of those that could afford coverage purposely choose not to obtain it.

It is easy to get caught up in all the feel good rhetoric of health care for all until you think of all the folks that will revolt at the notion of having to purchase it (subsidized or not). And then when one realizes that there is no possible way for there to be access to primary care for all in such a scenario, you start thinking again that maybe this isn't all it is cracked up to be.

But then after those thoughts you think of the cheery happy insured nation of our dreams, and you are all full of grass roots optimism again, until you start thinking about how many physicians might just bail on accepting Federal insurance completely...

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