A Healthcare Rant

I’ve had occasion to think a lot about our system of health care lately. Bubba is doing a big project at work for a new client that revolves around prevention and healthcare education and I love kicking around ideas with him on our evening walks, especially because I love that this giant organization is thinking in this way. The questions are huge and the obstacles seem enormous, but so do the implications if they can find a way to pull it off.

With 8 million people and counting signed up for the Affordable Healthcare Act, as a country we need to get it together with respect to the way we deliver (and even think about) healthcare.  In Washington state, the number of folks eligible for the Medicaid expansion has outpaced their wildest imaginations and it is increasingly becoming obvious that we need a new game plan in order to serve these people. Many providers refuse to take Medicaid and even Medicare because the reimbursements are so paltry compared to private insurers and there is a big question looming about whether or not we’ll be able to find enough qualified practitioners to treat these new patients.

While we may utter the word “prevention” a lot with regards to health, the simple fact is that the vast majority of people don’t truly understand what that means or how to put it in play in their own lives.  Yes, we all pretty much know that our lives will be better if we get enough sleep, manage our stress, eat healthy, exercise and don’t smoke or do drugs, but actually knowing how to implement those things regularly and effectively is tremendously difficult.  When so many people, especially those newly eligible for health insurance, are struggling to pay the rent every month, finding the time to locate honest resources where they can educate themselves about what healthy food is or learning effective stress-management techniques is pretty far down on the list of priorities.

So where do most people get their information about health care? Not from their physician, it turns out, because as a system, our health care priorities lie in treatment of symptoms and deployment of technology, not conversation.  Doctors get paid to write prescriptions and schedule surgeries or diagnostic tests, not to sit with their patients for an hour at a time and help them understand how to read a food label or coach them in relaxation techniques or set up a viable exercise plan.  And while there are some physicians who take the time to really listen to their patients and explain things in depth, it isn’t always easy to remember exactly what they said once you leave the office.  Yes, it is possible to find people who will teach us about nutrition and stress management and exercise, but they are rarely paid by insurance companies and most people can’t afford their services.  Why don’t we make it part of our health education to offer those services in the doctor’s office as part of the care? The first real nutrition education my mother got from her healthcare provider was a class on how to eat after being diagnosed with diabetes. Helpful, but maybe classes on how to avoid diabetes in the first place would have been better, given that now Medicare pays hundreds of dollars for prescriptions every month that might have been unnecessary.

I predict that, thanks to the ACA, many healthcare providers will find themselves overwhelmed by a glut of new patients with complicated health histories. There are some who are relatively young and healthy who have signed up for coverage and may choose to establish a relationship with a physician, but there will be many more who have suffered with chronic conditions for years because they couldn’t afford to have someone treat them.  It is here where the rubber meets the road and, I think, the issue that will prove to be the stickiest for this much-needed leap forward in our healthcare system.  A doctor who sees a middle-aged person with multiple complaints that have been ongoing for years will be hard-pressed to find enough time for a comprehensive introductory examination that can unravel years of health issues. Most of these patients will end up leaving their first doctor’s appointment in years with a fist-full of prescriptions that may or may not make a significant difference in their long-term health, and will more likely treat symptoms instead of causes. Additionally, if the fee schedules don’t change, the folks who have to pay for some portion of their prescriptions may find themselves unable to afford the treatments they’ve been offered.  Without some effort to integrate these individuals into a system that educates them and offers them someone to collaborate with when it comes to preserving their health or reversing chronic conditions, we are destined to continue to have the most inefficient, expensive healthcare system in the nation, albeit one that is covering more folks than ever before.  Until we revamp our priorities by paying more for consultations and less for quick-fix deployment of technologies like surgery or prescriptions, we can never hope to turn the tide from treatment to prevention. We will always be playing catch-up and we will never catch up to our national obsession with fast food and sugar and vapor cigarettes as a viable alternative to regular cigarettes, because we haven’t been educated by people who have credibility, with whom we have an ongoing relationship. We have to enlist our healthcare providers as educators and partners and pay them to work with patients to keep them healthy and help them make good choices instead of giving them incentives to do expensive surgeries and prescribe drugs that treat symptoms. Until we are willing to turn our attentions from quick-fix ideas to long-term prevention strategies, we are doomed to continue down this path of being one of the unhealthiest countries in the world. With some of the most educated healthcare workers in the world, it is an absolute tragedy that this is the situation we find ourselves in, but if we choose to use doctors and nurses as collaborators instead of auto mechanics, we can make a difference.