The major requirements of a good healthcare system that most of us can agree on are:
- Universality - Everyone is included
- Choice - Each person has a choice of provider
- Quality - As excellent a service as can be achieved
- Reduced Cost - At least as inexpensive as systems of other industrialized nations
We do not have universality. About 47 million are uninsured. The poor are not covered. Self-employed have a tough time getting insurance. Many workers losing their jobs lose their health insurance as well.
I'm sure that both Republicans and Democrats agree that we must correct this unfortunate situation. Naturally they have different approaches. Republicans prefer to keep the current private system as is and add a few modifications. Democrats prefer a government-run single-payer system, such as they have in Canada.
Republicans talk a lot about choice. In the current system, a patient may go to any doctor, hospital or other medical provider. Yes, indeed, if you have the money you can buy whatever healthcare you need. What about the indigent? Do they have a choice? What about the permanently disabled and chronically ill? What's their choice? What about those terribly sick people for whom insurance companies do not offer any kind of insurance?
The Democratic answer is that though we prefer a single-payer system we can settle for at least having a public-sector component to which any individual may apply. Let's keep the Republican-approved private-sector insurance system - with appropriate laws assuring that all who apply are insured. But the public sector is needed for those dissatisfied with available insurance policies.
Republicans claim that a public sector would compete unfairly with the private sector. I don't understand. I thought the Republican mantra is that the government cannot do anything well. If so, why be afraid of government competition? Democrats insist that without a public choice the system will essentially be the same as it is. As Howard Dean says:
Give America a choice. We support health care reform that allows individual Americans to choose either a universally available public health care option like Medicare or for-profit private insurance. A public option is the only way to guarantee health care for all Americans and its inclusion is non-negotiable.
Any legislation without the choice of a public option is only insurance reform and not the health care reform America needs.
The other 2 requirements are quality and cost reduction. Currently, U.S. spends about twice as much on healthcare as do other industrialized countries. According to Richard Kirch, "health insurance premiums have gone up six times faster than wages in the past nine years." And what do we get for it? Very little compared to other countries, such as Sweden, where citizens live longer, are healthier and receive superior care when ill than we do in the U.S.
Both gaining quality and reducing cost may be achieved through a properly designed medical information system. Among the many quality problems are choosing the best provider, making sure prescriptions are correct, establishing medical standards, gaining immediate access to files, learning about new research and inventions and much more. All of these quality problems may be solved to a great degree with a comprehensive medical information system.
If you have visited a doctor's office lately, I'm sure you have seen rows and rows of bins and bins storing files. After you sign in, the receptionist searches and locates your file and then brings it to a desk in the examination room. My heart doctor has a file on me that is about 5 inches thick. Before he comes in to the room, the nurse makes sure that all the data in the file is in order. This is a terrible waste of space, energy and time when we know that a broad medical information system could do away with this inefficient system. Imagine the smaller office with less storage space and with less manpower. This gives you a small inkling of the possible cost savings an information system would bring.
A medical information system need not be centralized and need not change how different parts of the medical system function. Doctors, surgeons, doctor groups, hmos, hospitals, researchers, universities, pharmacists, insurance companies, Medicare and other entities may work as before. The big difference will be that people in one group may talk to those in another group.
The good news is that Congress already voted for a downpayment on the medical information system. We must now work to make sure there is a public sector to whatever is proposed in a future healthcare system.
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