Location can weaken understanding need for healthcare reform

“Hey, hey … Peter Rast has a letter to the editor in today’s paper!” I blurted out across the breakfast table this morning, to Mr. Maven. We know Peter from our days as collegues in the Nevada Wing of the Civil Air Patrol.

Peter is a well known and highly respected consultant and expert witness specializing in forensic engineering, accident reconstruction, and causation analysis. I’ve worked with him in Search and Rescue enough to know that he’s really, really sharp. He and I are about as far apart as humanly possible on the political spectrum, but I was still surprised to see the following:

Regulations are driving up costs

“I recently ran an old, rusty nail into my hand and needed attention. I was in and out of the emergency room after having my temperature and weight taken, my wound cleaned, and received a tetanus shot. Thirty minutes including travel time. Two follow-up visits took even less time. And no paperwork. My recent experience is typical of many ER visits over the years.

If one wants to see what government-controlled health health care will do for and to you, look at (sic)Bureau of Indian Affairs heath care, the VA, Medicare and Medicaid. Look at Canada and England. No one in their right mind would ever want such a system.

The main reason health-care costs keep rising is current levels of government interference. Rule after rule does nothing for efficience or efficacy - just makes things more expensive. The last thing we need is more government involvement in health care!”

Peter Rast, Blairsden, California

Well, Peter … so many visits to the ER? And this for an accident investigator? Oh, I jest.

In reference to the horrors of health care in Canada, actually the maven&meddler took a look at that just yesterday in a blog post. According to that Canadian citizen/correspondent, the state of Canadian health care ain’t so bad that he’s willing to give it up.

Having had a couple of emergency room encounters here in Reno lately, I wonder if the difference Peter is seeing with his ‘lighting round’ visits could be explained by the fact that they took place away from a large urban hospital.

The last visit with my husband, to a local big hospital ER resulted in us giving up and walking out after waiting for two hours, in an ER swamped with patients and short of staff. Paperwork wasn’t the issue.

Renown is now operating with two Certified Nursing Assistants (CNA) to an entire floor of patients plus clerical and cleaning, having done away with clerical and janitorial staff. Could that possibly result in an effecient, better level of care?

Could the difference between the ER care in Blairsden or similar towns and Reno be due to size, and is his treatment typical ( and reproduceable ) among all towns of similar size across the country? Does the area matter?

Yes, it does. Very much, indeed.

According to an article by Steve Sternberg of USA Today, quality and cost of health care vary wildly from place to place around the nation. Experts, the article says, point to this fact as a clear indicator that the ‘system’ in on life support and not expected to survive without agressive emergency intervention.

“The current system is so broken,” said Dave Brooks, CEO of the Providence Regional Medical Center in Everett, Wash. “It’s not allabout financing. It’s absolutelycritical to cover these 46 million people who are not covered, butultimately, we’ve got to reconstruct the way health care is delivered.”

As in accident reconstruction, which seems particularly appropriate here. Our existing ‘private’ ‘system’ of delivering healthcare is more like a trainwreck. If this is what passes for working, I’ll be damned.

The main problem here, as I see it, is too many people chanting the mantra of ‘government involvement can’t do anything but make the situation worse’. A careful,open minded look at other government mandated health care delivery systems around the world show this to be categorically untrue and more than a little disingenuous.

Additionally, while fixating on the evil specter of ‘government involvement’ these very same people are missing most of the salient issues that, if they could be resolved, could put the citizens of the United States further ahead, healthier and more prosperous in exhange.

Among them:

Develop better measures of quality (outcomes)and cost to drive higher-value health care deliver systems.

Reform the payments to providers in addition to the financing of care. The consensus is saying that the old fee-for-service (FSS) model promotes overuse of treatments that don’t necessarily lead to better outcomes and generate unnecessary costs.

Get a better picture of what really works. We been too long assuming that all expensive, high tech or novel measures lead to better outcomes. Studies are not showing this to be true. As a component of this, new technologies or techniques that do result in better outcomes should be fast tracked to the patient population. This is one of the reasons that my hospital, The University of Texas, M. D. Anderson Cancer Center has such a high number of positive outcomes, despite the large numbers of patients who enter the system as a last ditch effort to survive.

Accelerate reform efforts and the state and regional levels. Nevada should be first in line here, since it seems to perennially rank at the bottom with places like Alabama.

Facilitate the broader adoption of health information technology (IT) as a tool for enhancing quality, efficiency, and transparency in the health-care system. Health care has lagged behind all other major industries in adopting IT to promote effeciency and better productivity.

The entire structure of the current system is designed to avoid addressing these problems in any meaningful or comprehensive manner. You just can’t, when you’re busy chasing the bottom line and a chirpy quarterly profit report.

Only government, without the vested interests, can effectively do this. But only the people can force the government to do what it must.

As long as our friends, neighbors and collegues view government as the enemy, that can’t happen.

maven