Sunday, September 6, 2009
Steamboat Springs As a physician, I think health care reform is essential:
First, I think strongly that we need health insurance reform. We have to be concerned about the health of our communities. We need universal coverage for all Americans regardless of pre-existing conditions, employment, residence or where medical care is received. In order for this to work, those who are healthy need to participate in the system just as those who are ill. I also think that we need a mechanism for increasing competition within the insurance market, and so far the public option seems like the best mechanism, either through private enrollment in Medicare and/or Medicaid or a separate plan.
How can we afford to cover those 46 million uninsured people?
This is what health care reform is really about - the changes we can make in delivery to improve care while putting the lid on the runaway costs that are escalating at an unsustainable rate of more than 9 percent per year.
Our system of health care is actually an inefficient health care system, despite the fact that we spend more on medical care per person than any other country. We deliver very good, high-intensity acute medical care when people get into serious trouble, but we neglect much of the inexpensive and more cost-effective care.
How can we move our spending to more effective care?
One, we need to make sure that children and young mothers have good preventive care. If young mothers get preventive care at all economic levels, infant mortality and morbidity, which is very costly in both the short and long term, will improve.
Two, because our biggest health issues are chronic diseases, we need screening and earlier interventions, and we need far better chronic disease management within the health care system.
Three, our system is fragmented both in information sharing and in service coordination. The result is that many parts of the medical system do not operate in the best interests of patients. Doctors order too many tests, too many marginally effective treatments and drugs, and recommend too much surgery. We need incentives and systems to provide more coordinated care that doesn't lead to duplication.
Any changes we implement now will certainly not be perfect and will need continuing adjustments, but by emphasizing early preventive care, chronic disease management and patient-centered care, we can create a framework that will provide improvements in health care before we are all dragged under by the system.
Carole Milligan is the medical director of Hospice of Northwest Colorado, chairwoman of the Ethics Committee at Yampa Valley Medical Center and a retired radiation oncologist.