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Health
care a major issue in the US Presidential elections
Dr
R Neerunjun Gopee
In
the World Health Report 2000 titled ‘Health Systems:
Improving Performance’, the US was ranked 37th
in overall performance. This was despite the fact that the
US spends the highest percentage of GDP on health, 16%
(expected to rise to 20% by 2020). Although there was much
criticism of the methodology devised and used for the
purpose of ranking, this was no doubt an important and
revealing exercise, and the first of its kind ever carried
out on a global scale. By evaluating in a
standardized manner the functioning of the health system of
individual countries, it raised awareness and interest in
health systems and health care delivery firstly at country
level itself, and next forced countries to look afresh at
the weaknesses in their systems and undertake reforms. Sure,
not all such reforms have produced dramatic turnarounds, but
at least the efforts have been on, and there is both
pressure and incentive to get results and enhance
performance.
Health
and education are considered to be the two cornerstones of a
country’s development, and it is no wonder that wherever
general elections are held in the world, these two sectors
assume great importance. This has been so in the US
presidential elections too. An amazing 47 million Americans
– nearly one sixth of the US population – has no
insurance coverage, meaning that they do not have access to
health care facilities, mainly because of the costs
involved.
Reporting
on this issue recently, a French TV channel featured a film
coverage of a ‘health camp’ in Virginia. Over a weekend,
whole families had driven for hours to come and wait for
hours more at pre-dawn, to get basic services such as
vaccination and dentistry from volunteer doctors assisted by
other health professionals. The latter could not handle
everybody at the end of the day, and through a loudspeaker
announcement the unlucky ones were requested to ‘try their
luck’ the next day, that is they again had to come in
early and await their turn for hours.
For
Americans who, through insurance, are able to access health
services, there is no doubt that they get the finest care in
the world. But there are many problems in the American
system of health care organization, financing and delivery.
Since Barack Obama has won the elections, it is instructive
to look at some of the ideas he ventilated about health care
in an article commissioned by the New England Journal of
Medicine before the elections. Extracts from that
article:
*
Doctors and other
health care providers work in extraordinary times
and have unrivaled abilities, but increasingly our health
care system gets in the way of their sound medical
judgment. Increasing uncompensated care loads,
administrative rules, and insurers' coverage
decisions inappropriately influence the practice of
medicine. Washington sends dictates but no help.
*
We need health
care reform now... Reform must emphasize prevention, not
just treatment of the sick; reduce medical errors and
malpractice claims; and make the practice of
medicine rewarding again.
*
My health care
plan has three central tenets. First, all Americans
should have access to the benefits of modern medicine.
Second, we must eliminate the waste that
plagues our medical system — layers of bureaucracy that
serve no purpose, duplicative tests and procedures that
are performed because the right information is not
readily available, and doctors providing
unnecessary care for fear of being sued. Third,
we need a public health infrastructure that works with our
medical system to prevent disease and improve health.
*
…my plan will
offer a choice of affordable health insurance plans. All
insurance companies will have to take everyone, regardless
of medical history. To make insurance affordable, we
will give families income-related tax credits to
expand access… And I have specified how I will pay for it
— by cutting out waste in the system and
redirecting the Bush tax cuts for the wealthiest
Americans to help middle-class families afford
health insurance.
*
Health care reform
will not succeed unless we create a health care
delivery system of which we can be proud. Report after report
has pointed out the flaws in the way our system is organized
and financed. Clinicians face huge administrative
burdens that add to the cost of care and rarely
improve its quality… And U.S. physicians practice with
constant concern about malpractice lawsuits.
*
My plan calls for
investing $10 billion per year over 5 years in
health information technology. This commitment is
not just financial: we will ensure that physicians have
the technical support they need to implement new systems
for patient records and billing. By reducing medical
errors and unnecessary duplication of tests, this
investment will lead to a long-term reduction in
our health care system's overall cost.
*
…we need to
ensure that doctors have ready access to the best
information on medical advances throughout their careers.
The best source of information on the value of a drug
or a new technology is not the company that
produces and markets it, but rather a careful and
independent evaluation of patient outcomes. I
will develop an independent national institute to work with
the medical community to evaluate and disseminate
information on the comparative effectiveness of
drugs, devices, treatments, and procedures.
*
I will address
medical malpractice with the central goal of
preventing medical errors in the first place. Through substantial
investment in information and decision-support technology
and other patient-safety initiatives, we will reduce
the types of medical errors and oversights that
lead to lawsuits. And I am open to additional
measures to curb malpractice suits and reduce the
cost of malpractice insurance. We must make the practice
of medicine rewarding again.
*
Prevention is also
a central part of my reform plan. Health care
providers can do only so much; patients, employers, and
communities all have a role in helping us to start out
healthy and maintain our health. Patients need to
step up their efforts to stop smoking, start
exercising, and eat right to maintain a healthy
weight. Employers need to invest in healthy workplaces and
help their employees maintain an active, healthy lifestyle.
*
Government has a
role, too. I will make new funding available for
community-based programs aimed at priority public health
problems such as smoking and obesity. I will also
reward school and workplace health-promotion and
prevention initiatives that increase vaccination
and exercise and make healthy foods available in
cafeterias and vending machines. Finally, I will work with
state and local governments to create a coherent,
coordinated national public health strategy.
The
NEJM also published in the same issue John McCain’s
article, titled ‘Access to Quality and Affordable Health
Care for Every American.’ Here some equally illuminating
extracts:
*
…the road to
reform does not lead through Washington and a
hugely expensive, bureaucratic, government-controlled system.
Our challenge is to protect and improve the care that
doctors, nurses, and hospitals deliver, while
increasing the availability and affordability of
health insurance for Americans. …we can do this in a
simple but powerful way: restoring doctors and
patients to the center of health care decisions.
*
… the starting
point for any health care reform must be
restoring the doctor–patient relationship.
*
I support a
comprehensive and inclusive approach to lowering costs
and reforming our health care system with a focus on four
pillars:
- Access
and choice: American families — not government
bureaucrats or insurance companies — should
choose the coverage that best meets their
unique needs.
- Quality:
Strengthening health care quality requires promoting
research and development of new treatment models,
promoting wellness, investing in technology,
and empowering Americans with better
information on quality.
- Affordability:
By rewarding quality, promoting prevention,
and delivering health care more effectively and efficiently,
we can ensure that all Americans can afford the health
care coverage of their choice.
- Portability
and security: We must allow Americans to keep their
health insurance as they move from job to job or
job to home, and we must protect Americans'
economic security from unforeseen health
events by expanding coverage and savings options.
*
Doctors and
patients understand that care bureaucracies — both within
government and within insurance companies — often impede
the effective delivery of high-quality care. I believe that
we can use government programs … as a lever of
change that improves quality and lowers costs, rather than
allowing it to be an obstacle to effective patient
care.
*
We need to create
a next generation of efforts to prevent chronic disease,
early intervention programs, new treatment models, and
public health infrastructure. We need to use technology
to share information on "best practices" in
health care so that every physician is up to
date. We need to adopt new treatment programs and
financial incentives to promote healthy habits among
Americans with the most common conditions, such as diabetes
and obesity, in order to improve their quality of life
and reduce the cost of their treatment.
While
we take steps to lower health care costs, we must also improve
access to health insurance. An important part of my plan
is to replace the current tax exclusion of the value of
health insurance from employees' taxable compensation
with a new refundable tax credit of $2,500 for
individuals and $5,000 for families. Families can
use the tax credit to continue their employment-based
insurance or to find a plan that better meets their
needs.
*
When Americans
speak of "my doctor," it will mean something
again.
*
Our tort system is
an invitation to endless, frivolous lawsuits by
trial lawyers who exploit patients and physicians alike.
I understand that the fear of lawsuits not only forces
doctors to perform unnecessary tests but also
often poisons the relationship between patients
and doctors. That is why I have been a consistent advocate
of medical-liability-reform legislation, and I believe it
must be a central aspect of any health care reform effort.
*
The key to real
reform is to strengthen the doctor–patient
relationship and provide American families with
more choices for high-quality and affordable care.
I
believe that these ideas need to be widely available and
thought upon, as they represent a distillation of what is
amongst the best in the world on the issue of health sector
improvement. We have a lot to learn from these two articles.
RN
Gopee
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