By Dr. GEORGE SPRECACE
As a practicing physician for 55 years, and as an attorney practicing and studying health care law for the last 28 years, I have been writing and publishing on this subject for decades. Much of this production is available on relevant sections of my web site (www.asthma-drsprecace.com).
In fact, an early publication, dating back to 1978, could be re-published with only minor revision, reflecting how little progress our society has made in addressing the real issues of health care reform.
The Affordable Care Act is a Christmas tree of "wants" that gives short shrift to the real needs awaiting health care reform. If not struck down by the U.S. Supreme Court this week, this ode to political expediency needs to be repealed and replaced.
With what, you say? Try these six steps.
Penalize poor behavior
Nearly half of health care expenditures in this country are directly life-style related: obesity, tobacco use, alcohol abuse, illicit drug use, irresponsible motor vehicle practices, the governmental support of unhealthy personal practices like abortion, children out of wedlock, defending failed schooling, etc. These practices should be heavily taxed and otherwise discouraged instead of being supported as "personal choices."
Don't futilely prolong life
A large percentage of health care costs incurred by individuals and by society occur during the last six months of a person's life. This, while a strong majority of adults support advanced directives and a small minority of them actually have such "personal choice" instructions to guide their loved ones and their physicians. Furthermore, physicians should recognize that they have an ethical obligation to refrain from offering "futile care."
At least 20 percent of health care costs represent "defensive medicine," defined as actions taken by health care providers predominantly to protect themselves from allegations of "medical malpractice" adjudicated in a lucrative and unnecessarily adversarial system. The current practices should be replaced by Health Care Courts similar to Patent Courts and Bankruptcy Courts. Only in that way can justice be achieved and defensive medicine minimized.
The great need in the existing system of health care delivery is "coordination of care" among the increasing number of medical specialists and other health care providers involved in much, if not most, of current patient care. Such services are time-consuming and require a broad-based knowledge of medicine to be effective. They can be provided by any one of a patient's physicians who is willing and who has the necessary level of insight and expertise. And they must be paid for adequately!
Yes, ration care
There must be established and enforced - by society as a whole and not by the medical profession - a system of prioritization (rationing!) - among the many services and potential recipients of those services. Coverage of cosmetic surgery and of Viagra does not rise to the level in importance of immunizations. Right now, cynical efforts are being made to force physicians to make such decisions through unethical mechanisms such as "accountable care organizations" that place a physician's self-interest in direct opposition to the interests of his or her patients.
Payment for all medical care, subject to clearly defined exceptions for indigence and serious medical necessity, should require at least a 20 percent co-pay by the patient. The patient must be a serious first decision-maker in his quest for medical care. For, once a patient enters a physician's office, the cost is generated and the service is provided. The physician cannot and will not be the arbiter of the "need" for the care requested - or demanded.
What is the prognosis of the above six vital areas of reform being addressed and implemented any time soon? Poor to Grim.
Meanwhile, actions in the direction of the ACA and of "universal health care" will produce the opposite of the desired goals: lower quality, at higher cost, with reduced access.
George Spercace lives and has his medical practice in New London.