HEALTH CARE #1

I promised to post one or more “articles” on health care reform. But, before I can make any sense out of the plans that may be on the table, I am providing some background in order that you can appreciate my comments with a “jaundiced eye”. That is a medical term meaning in the vernacular as skeptic.

Way back in the dark ages (1946) when I returned from service and assumed my father’s practice a physician was a healer not an entrepreneur. Oh yes there were a few who used various tricks to impress the public, like being paged daily during public visiting hours at the hospital or paying non patients to sit in the waiting room to give the appearance of being popular, or excessive use of mechanical devises. Most however genuinely desired to treat the ill with the best methods available.

There was an intimate physician/patient relationship without which care could, no would be ineffective. The doctor or his substitute was available 24/7, and many a home or ER visit was made in the middle of the night. Telephone contact was readily available either directly or through a human operator at “Answerphone”. The office visit was either $3.00 or $4.oo and house calls were commonly $5.00. Very few charged extra for after hour’s calls and most held evening office hours several days a week. This was your “Norm Rockwell” concept of the “family doctor”.

I will not go in to the changes in diagnostic aids and therapeutic modalities at this time since I have already done so in the past. I will discuss the impact in the next section.

When did things undergo a change? It was not the great advances in diagnostic tools or the explosion in curative medication. Instead it began with two Federal sponsored plans, Medicaid and Medicare and exploded with the advent of the HMOs.

Significantly, the physician was no longer referred to as a MD or doctor, but as a PROVIDER. I for one consider a provider as one who supplies a commodity. Health care had become a commodity similar to gasoline for the car.

To further accelerate the change the government programs began cutting reimbursement to hospital and doctor alike and the HMO’s not only reduced reimbursement but restricted the patient’s access to a limited number of “providers” many who were under contract and no longer fee for service but based on the number of individuals in their panel.

The change in medical practice was also influenced on the great number of malpractice suits which increased not only the physician’s overhead with rapidly escalating insurance premiums but also change the focus of care from the patients needs but to avoid any possible misadventure by over using external diagnostic tools. Many of the later like the MRI were unknown even as late as the late 60s, even unto the 80s.

Another problem was the overwhelming amount of paper work that resulted in the need for extra office personnel. All this, briefly, necessitated an increase in the doctor’s office staff, and resulting to a need for rapid turnover of patients in the office accomplished by a very brief Physician/Patient encounter.

All of this encourages a change from healer orientation to “bean counter” to make a living and ultimately to game the system at the patient’s expense.

All this is really perfunctory in addressing the physician component in the cost of medical care. The $4.00 office visit in 1946 or the $40.00 routine visit of 1980 compared to today’s $80.00 visit reflects the declining purchasing value of the dollar, not gouging as some would suggest. A gallon of gasoline cost 17 cents in the postwar 40s, a car less than $1000.00. In the 80s gasoline was far below $2.00/gallon. We have a running inflation.

In the next segment I will continue to address other “table setting factors” in the cost of health c are before we can analyze any of the proposed plans.