Thursday, April 19, 2018
Opinion

Column: U.S. health system not good for what ails us (w/video)

Recent revelations in the Tampa Bay Times about charges for trauma center care and the fees some practitioners are collecting from Medicare are disturbing on a number of levels. They point out excesses in our health care delivery system — currently more than $2.6 trillion annually (18 percent of GDP) — that, if left unchecked, will bankrupt our society.

Health care expenditures in the United States exceed those of every nation in the world. At the present rate of growth they are estimated to reach $5 trillion (20 percent of GDP) by 2021. Yet our average life expectancy at birth of 79.6 years ranks us 42nd in the world, behind, for example, Japan (84.5), Italy (82), France and Canada (81.7), Spain (81.5), Germany and the United Kingdom (80.4), Greece (80.3) and South Korea (79.8).

A system that is dependent on fee-for-services leads health consumers to believe that the higher the cost, the greater the quality of care. But such beliefs are not supported by the facts. More important, our present health care system not only shortchanges the public but health care providers as well by corrupting the sacrosanct relationship between practitioners and patients.

The business model predicated on caveat emptor (let the buyer beware) may work well when shopping for a used car, but the foundation of professionalism is a relationship of trust between practitioners and patients. Professionals are supposed to place the best interests of their patients above remuneration. It is said that a professional does not work to be paid but is paid so she or he may be able to work.

Naive and uneducated consumers do not have the knowledge to evaluate the quality of health care they receive. They trust their practitioner is providing them with the highest quality of care without regard to their ability to pay, insurance, age, gender, ethnicity, religion, political views and sexual orientation.

The high cost of pharmaceuticals, malpractice insurance, equipment and tests further attenuates the doctor-patient relationship. It replaces trust with doubt and suspicion. The current health care delivery system is characterized by mistrust because practitioners are dependent on individuals and insurance companies for their sustenance, and patients wonder whether the care they receive is necessary or sufficient based on their ability to pay.

In an ideal society — and, indeed, for most of the industrialized world — the business model would be rejected in the sphere of health care, where health is viewed as a basic human right, not a privilege. Unfortunately, it has become inextricably intertwined with business values in the provision of services in the United States, producing aberrations as we have seen in recent days.

Searching for health care in the United States has become a multimedia experience exhibited through advertisements on television, billboards, radio, newspapers and the Internet with catchy phrases, comely models and unsubstantiated and misleading claims for care and cures. And contrary to impressions on ubiquitous billboards in the region, quality outcomes of emergency services cannot be measured by waiting times but by competent, dedicated staff and availability and judicious use of resources.

Health care costs in the United States are the greatest cause of bankruptcy among the middle class. When was the last time you heard about a fundraiser for an unfortunate person who needed health care? Even with the Affordable Care Act, there are still over 40 million uninsured people in this country, many of them children, and yet 24 states, including Florida, have not implemented Medicaid expansion.

If the public wishes to change the character of patient-practitioner relationships and health care outcomes based on prevention instead of illness, and restore the bond of trust between practitioners and consumers, they should consider revising the present "system" that is spiraling out of control, damaging both practitioners and patients in a climate of fear and greed.

H. Roy Kaplan was executive director of the National Conference of Christians and Jews for Tampa Bay. His latest book, "Understanding Conflict and Change in a Multicultural World," will be published shortly. He wrote this exclusively for the Tampa Bay Times.

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