Monday, September 21, 2009
American values and health care
I read a good post from the New York Times about Health Care Reform and 'American Values' and it got me a thinkin' ... just what are American Values when it comes to health care? Usually I get a little anxious when I see "American Values" in a sentence, because what usually follows is something about rugged individuality, pulling oneself up by bootstraps, getting the damn government out of our lives and those damn immigrants and welfare mothers who won't work and want to live off others.
But I have listened to about ten thousand patients over the past 25 years, and I have a good idea of what these Americans want for health care. They are the silent majority ... the people who work, study, raise their kids and seldom call into a radio talk show. They don't have time to go to town hall meetings and shout slogans.
They range from age 17 to 101 and most of them are middle class. They come in all races ... Asian, black, white, Pacific Islander and mixes of all.
Some are wealthy enough to have multiple homes and private planes.
Some are uninsured and watch their health care spending very closely. Most were thrilled to get Medicare and I've never heard a complaint from a Medicare patient.
Here is my list of what these Americans think about health care:
--They do agree that everyone should be covered for basic health care and would pay higher taxes if they could believe that there would not be fraud and waste. (The recent banking meltdown has destroyed all confidence that government can regulate or be independent from special interests.)
--They want choice of physicians and hospitals.
--They are sick of insurance companies and all feel like they have been screwed in one way or another. They are shocked at how little insurance companies pay toward the doctor visit and the way those fees are discounted.
--They are technocentric and want tests, imaging, referrals and think "more is better" when it comes to health care. They think tests are cures. Because of the perverse incentives, the "more is better" philosophy benefits doctors and hospitals, but not necessarily patients.
--They fear losing insurance if they have it.
--They are confused about the current reform debate and mostly fear losing whatever coverage they now have, because they know how impossible it is to get by without any coverage at all.
There are no such thing as "American Values" because we are a diverse group of people. But we all have certain things in common. We want to be healthy. We don't want to be screwed by anyone (big business or the government).
We want to be able to manage our own health care but we don't want to have to decide between numerous health plans every year with pages of information that cannot be understood. We are tired of not knowing where all the trillions of dollars really are being spent.
We want to know the price of a service up front, and we want a trusted physician to help us decide if that is how our money should be spent. We want smart, committed physicians to know us, and not hurt us.
Sounds American to me.
Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
Labels: health care reform, health insurance, pay-for-performance
posted by Toni Brayer, MD at
8:00 AM
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Albert Fuchs,
MD
Albert Fuchs, MD, FACP, graduated from the
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she which chronicles her journey through medical training from day
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Run by three ACP
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Robert M. Centor, MD, FACP, contributes short essays contemplating
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DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about
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Matthew Mintz, MD, FACP, has practiced internal medicine for more
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Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science,
medicine, health and healing in the 21st century.
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Vineet Arora, MD, FACP, is Associate Program Director for the
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MD
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Rob Lamberts, MD, ACP Member, a med-peds and general practice
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Peter A. Lipson,
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Peter A. Lipson, MD, ACP Member, is a practicing internist and
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Why is American Health Care So Expensive?
Janice
Boughton, MD, FACP, practiced internal medicine for 20 years before
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tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD,
FACP, is an internal medicine physician who has avidly applied
computers to medicine since 1986, when he first wrote medically
oriented computer programs. He is in practice in Tacoma,
Washington.
Other blogs of note:
American Journal of
Medicine
Also known as the Green Journal, the American Journal of Medicine
publishes original clinical articles of interest to physicians in
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Clinical
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Member, associate program director at New York University Medical
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Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so
he can create an independent, clinician-reviewed space on the
Internet for physicians to report and comment on the medical news
of the day.
PLoS Blog
The Public Library of Science's open access materials include a
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White Coat
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One of the most popular anonymous blogs written by an emergency
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2 Comments:
Dr. Brayer, this summary of what patients want rings true. I think they also want health care to be easy and uncomplicated. It is hard enough to think about one's health without worrying about how it will be covered and who is in-or-out of the plan. Great post.
Most Americans want more than the system can provide. We all want superb health care that we can afford. We want all Americans to have at least basic health care coverage. We want access to every conceivable medical benefit or treatment, regardless of the cost. We want specialty care on demand. We want relaxed physicians with soft bedside manners. Are these goals achievable or reasonable? www.MDWhistleblower.blogspot.com
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