SOMETHING ABOUT HEALTH CARE

(I promised to post before 5pm)

Too much water has passed over the dam in the past two weeks when I had first intended to once again address the status of American Health Care. I can only skirt around the edges and hit on targets that reflect the deterioration of what was once the best system in the world.

One document that should be read was printed in the Wall Street Journal earlier this week which was a comprehensive review of why we are developing a double standard health care system; the one that we  are getting due to "universal health care" and the superb system available to those who can afford it.
(I had a link to that article however when I tried it today I found that it is only to the present day's edition. It was too long to copy or to get permission to reprint.)

The ersatz rationing of care that is already in existence as a result of the Nixon generation HMOs is going to worsen. The various European socialist oriented nations that have been held as models of universal health services have either had failures due to fiscal problems that have resulted in restrictions on readily available services or treatments.

Even in Sweden which has been held up as the best example of universal care  there is a developing private segment to counter act the prolonged wait, often months, for critical surgery or diagnostic testing. Those who can afford it will opt for this route; even though they by law are participants in the universal care.

Health care is now big business. Hospitals and large groups are buying independent practices to control patient flow into their hands. The number of physicians who receive a salary (employed) rather than having a ‘”private” or small group practice is now over 60% (a 2013 Primary  Care Docs)  and is rising rapidly. Economic forces and rules/regulations are a costly burden that overwhelm individual doctors.

There have been almost daily articles in the Times and in other news media relating to various problems resulting from weird interpretations of the ACA laws. 

Among them are certain tests and studies which are "free" if done as part of a “wellness exam” but if done for diagnostic purposes the “Exchange acceptable policy” will not cover.

An example if a woman has a mammogram as part of a wellness exam it is free but if it is done to because a lump had been found in the breast it may not be covered.

Another new regulation is the reporting of physicians as good or bad based on group of criteria which fail to take into consideration of extraneous factors. For example a doctor whose patient load is burdened by high risk patients will have a higher failure rate that one in which the majority of the patients are low risk. 

Among the determining factors are the frequency of hospital admissions or readmission within 30 days.

The pressure to see more patients per hour has resulted in examinations practices that I find to be of poor quality but satisfies that need to put a check mark on the chart. Today’s doctor most often auscultates the lungs and heart through layers of clothing. That must compromise what is heard if anything. The stethoscope needs to be on the skin to hear many heart murmurs or lung pathology.

When I practiced back in the dark ages good physicians could diagnose tuberculosis or collapsed lung tissue, pleurisy, by listening and then order if need confirmatory x-rays. Today the x-ray or CT is requested often before the chest is truly examined.

Blood Pressure is taken by compressing the artery with the cuff and listening for the sounds to appear and disappear. Today the doctor or the assistant will place the cuff over clothing which affects thee pressure needed to compress the artery; but that saves time.

Medications are prescribed not by the best drug available but by the one the insurer will pay for even if it may not be as effective. In many cases similar but not chemically the same drug’s effectiveness differs in different patients but cost not results determine what is prescribed.

These are only a few of the forces which are destroying quality of care.  Henry Ford said about his Model T; “People can have any color they want as long as it is black”. Americans under ACA can have universal care as long as it is inexpensive.