I am alarmed that Hillary and Bill Clinton are moving in precisely the wrong direction in their attempt to meet the crisis of health care. They are unfortunately still approaching the health-care problem the way it has been approached in the past, following the same path that got us into this bad situation.
The patients I see all have horror stories of ineffective treatment, enormous expense and a loss of control over their own medical destiny. If we are talking reform, why continue on that dreary path?
What we don't need is more dependency on drugs, technology and the rest of the "business as usual" practices of medicine. Yet that's all we hear--more money, more insurance, more medical intervention, less patient control and less interest in non-conventional alternatives. We have some legitimate alternatives right now that are economically feasible, viable and legitimate.
The Clintons need to expand their ideas about health care and recognize that throwing even more money at the problem will not solve it. There are innovative homeopathic alternatives available, for example, in the treatment of high blood pressure holistically without creating a drug dependency. But the barrier to exploring alternative health care is that the guys making the drugs and the ultrasound scanners would make less money.
This should be an occasion for examining new and innovative ways of thinking about health care and its delivery. To begin with, we have to reintroduce the notion of patient responsibility, which has all but been destroyed by the third party insurance payment system and which I fear will be exacerbated under the new program.
One place to start would be with the Medicare card, which is like a free medical charge account where there is no patient consumer responsibility for the expenditure. As a result, one-third of Medicare expenditures occur in the last year of life.
My experience has been that almost all patients don't want heroic measures at the end of their lives, but often at that point their wishes cannot be expressed and the doctor, in fear of legal action and under pressure from the patient's family, must continue the costly extension of life. Why not ask these patients as part of their initial registration to document their wishes as to the limits of care? A simple act which promises great savings.
The Clinton approach is to extend the access of everyone to the existing system and make that existing system better at producing more machines and more drugs.
That in a nutshell is what the Administration and the American Medical Assn., the powers that be, think. But in the last five years we have thrown a lot of money at the problems in this way, we have had lots of new drugs and new technology and we have more devastating diseases, higher expenditures and worse health.
Maybe it's time to rethink the problem and approach it from a new direction. For example, instead of rushing out, as the President has suggested, with the idea of government making free immunization mandatory, it would have been far more cost-effective to put that money into school lunches because many health problems in schoolchildren are nutritional. In fact, that expenditure was not necessary and there were already plenty of government outlets for immunization. The problem has not been the availability of low-cost shots, as he assumed, but rather education about their necessity. Just another example of trying to throw money at the problem when that isn't going to solve it. The real issue is patient and doctor responsibility. We need to build in incentives for the doctor and patient to look at alternatives to drugs and surgery. Our system rewards doctors for doing procedures and testing and discourages the doctor-patient interaction. And the patient needs an incentive to be a conscientious consumer even though insurance seems to be paying his bills.
The attitude of most people is to do everything because their insurance is paying. That separation between the person receiving the service and the person paying has single-handedly been responsible for driving up health-care costs beyond all endurance. Unfortunately, the Clinton reforms, from what we've heard, are going to do more of that.
One innovation of some companies is to give the employee a cash disbursement to cover costs, letting them pocket savings and encouraging them to shop wisely. There are undoubtedly many more possibilities for advancing patient responsibility. Certainly one would be to permit employees to explore alternative health-care practices that are less invasive, often more effective and far less costly.
The patients I see are not covered by insurance and have chosen to pay for homeopathic medical care out of their own pockets because it works for them. The New England Journal of Medicine reported this year that patients are now spending more money out of their own pocket on alternative care than the total spent on primary care doctor visits. People are voting with their feet for some way out of the rigid and unsatisfying confines of traditional medicine. Why doesn't the Administration listen to them as well as to conventional practitioners, insurers and the drug companies?