Saturday, February 11, 2012

Is It True?

We hold these truths to be self-evident.

Declaration of Independence, 1776

February 12, 2012 – In any political campaign, each side seeks to convince voters that the truths it declares are self-evident, that it stands for social justice, individual freedom, and equity in all realms of life, business, government, and health care.

But all truths are not self-evident. Truths depend on how one spins them. This is true in health-care as well as other forms of human activity.

Is it true that the United States compares unfavorably to other countries in terms of longevity? Yes, it is true, but only if you just look at raw numbers. If you subtract U.S. deaths from violence and accidents, we rank right up there with the longest living in other nations. Violence seems to be one price one pays for freedom to behave as one pleases.

Is it true that doctors and hospitals are responsible for the high cost of care? Yes, it’s true. We health care professionals order and perform the tests that cost so much. But it’s also true that poverty and need, not greed, drives costs, and doctors and hospital cannot control poverty or the stage at which patients arrive with their illnesses. We can only respond to these factors and to other social forces beyond our control.

Is it true malpractice costs are high because of doctor negligence, carelessness, or chasing that extra buck? Yes, on rare occasion. But it is also true doctors are reacting to the U.S. “legal casino” system. By its rules, winners win big and losers lose nothing. And, it’s also true, if you’re a doctor, you cover your assets by practicing defensive medicine.

Is it true that women’s health issues in America have been neglected? They have been neglected, but only if you believe women are entitled to unlimited federal largess, if you classify routine or unwanted pregnancies as a “disease” rather than as ordinary health issue; if you believes sterilization, abortive drugs, oral contraceptives, and early abortions ought to be “free; and if you ignore the reality that the U.S, probably spends much more on breast cancer awareness than prostate cancer awareness, despite the more common occurrence of prostate cancer.

Is it true that that Americans lack access to care for diabetes, cancer, and to the technologies that restore life and life-style? Not if you consider comparative national statistics showing Americans survive cancer longer than in other nations, that they receive treatment for diabetes quicker, that they are referred to specialists faster, and that they receive hip and knee replacements within 6 months more expeditiously that other nations.

Is it true that that the American system lacks “value”; that it is “inefficient”, that it is bereft of “quality”, that fee-for-service encourages doctors to do more rather than provide “better care”, and that it lacks “coordination,” and promotes “duplication”? Sometimes, but 82% of Americans like the system the way it is, and we live in an imperfect democracy that believes in individualism and choice.

Is it true government can solve these problems by paying doctors to participate (and punishing them if they do not) in accountable care organizations, primary care groups, patient-centered medical homes, and by measuring and rewarding hospital quality (rate of readmission, imaging use, mortality and hospital infection rates patient satisfaction) and doctors (rates of hospital admission, ER use, total cost of care, percent of preventive tests recommended)? If you think this is a convoluted question, just wait and see how convoluted a bureaucracy it will take to enforce it. Still, itschampions say it's worth a try, even if private plans, market competition and incentives could do just as well – at less cost, more efficiency, and better outcomes.

Is it true we can do better? Absolutely, but it’s also a question of how we get from here to there, and how much by government controls and how much by private incentives.

Tweet: When one listens to health care promises during the national political campaign now underway, ask yourself “ It is true what they say?”


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