As a political and social moderate, I tend to vote conservatively in most national elections, yet more liberally in local ones. Perhaps this is because I believe in the rights of the states and localities to attempt to solve their own issues. I also believe, however, that the national government should strive for fairness and equality in the sharing of resources.
A few decades ago, while in medical school, I had the opportunity to complete a two-month community medicine rotation to study the Canadian health care system. Working and learning in Ontario, I discussed the system at length with doctors, nurses, social workers, members of Parliament and other politicians. I came away with a much better understanding not only of the similarities but also the distinct differences between our health care system and Canada's. Patients aren't much different, regardless of which side of the border they live on. They all have both health care needs and health care demands, and the distinction between them depends on each individual's perception. For instance, what the physician may perceive as a demand, the patient may regard as a need. Alternatively, what the physician considers to be a need, the patient doesn't demand. This creates a considerable disconnect.
After studying this need and demand conflict, and considering it over the past three decades of practice, I have come to realize that there are three main points that should be emphasized in any health care reform. These three points involve what I believe both providers and patients regard as needs, and I agree.
1. Insurers, providers, and/or governments should not be allowed to use pre-existing conditions in any way as including or excluding factors when deciding whether to allow or disallow any given medical care service. Excluding pre-existing conditions as a factor ensures that patients, employers and even insurers will realize they must take what comes. Patients should not be tied to any particular insurer, afraid to move or change jobs solely because of benefits. This would free up many patients, allowing them to pursue other positions, thereby enriching their own lives and even society as a whole.
2. Any fee paid to a hospital, clinic, physician or other health care provider should be the same for the same condition. It has never made sense to me why a coded condition can generate a higher fee in the same locality just because of a difference in site or circumstance. I understand this could create some major complaints, but if the fees were leveled, whether a physician fee or a facility fee, patient care could improve immensely. The ramifications are far reaching but much needed.
3. One of the biggest concerns I have for any patient is the financial devastation that can occur with an illness or injury. We talk about the inability to pay health care providers, but the real fact is modern medicine is so expensive that almost no one can afford it. I recommend, therefore, that our state and federal governments determine a way to provide or purchase major medical insurance coverage for all members of this country. The dollar amount of coverage should be something such as anything above $10,000, $15,000, $20,000, etc. This would ensure that no one could be devastated financially because of a major medical issue. These thresholds are certainly not trivial amounts, but I have seen patients with hundreds of thousands of dollars in medical fees they will never be able to adequately repay.
Once these three points are addressed, we then should spend some time addressing what to do about first contacts. Who should pay for physicals, for preventive medicine? Who should pay for secondary prevention? Minor procedures? All of these issues are complex, and it may take quite awhile to address them appropriately, but they do need to be addressed.
Finally, as the population ages and the baby boomers enter their later years, the concept of long-term care needs to be revisited. Instead of skilled care in a nursing home, the best solution might be a hospicelike long-term-care service, in which care may be provided in homes for patients who would like to continue to live at home. But that is another issue for later discussion.
David Parrish is the director of the Bayfront Family Medicine Residency and Sports Medicine Fellowship/Family Health Center in St. Petersburg.