New Haven Register
July 22, 2004
With health care crisis, the trees are obscuring the forest
Steve N. Wolfson, M.D.
Our health care system is in massive disarray, but we are focusing on the trees and missing the forest. This is most obvious in the “insurance state.”
This came home to me as I sat with a patient and she told me that she shortly will not be able to afford her medication. Her husband has been laid off from his job, and their insurance will lapse in three months. They will then join the uninsured, Americans whose prognosis for illness and death shames us all.
The trees: Faced with rising costs, declining reimbursement, and patients who are uninsured and unable to pay for services, formerly charitable hospitals are foreclosing on homes and garnisheeing wages. Faced with increasing barriers to reimbursement while malpractice insurance rates soar, physicians are leaving their practices and their patients.
Patients are foregoing needed medications and losing the opportunity to avoid illness. When illness comes, they are accumulating a crippling burden of debt. More and more of the burden of payment is being shifted to patients. The result is that expenditures that appear discretionary are being dropped.
Too often, this means preventive medicine is out. For those who cannot drop services, meaning those who are already ill, the burden is excruciating.
Meanwhile, businesses complain that the cost of health care for employees and retirees handicaps them in international commerce.
Faced with razor thin or negative bottom lines, the health care system as a whole copes with a rising tide of medical errors with an obsolete, incomplete information system and communications network. And those errors that are detected are snapped up by our legal colleagues, pursuing them within a tort system that with comparable inefficiency neither deters malpractice nor reliably compensates victims of negligence.
These are the trees. Newspapers are filled with examples of the injury done by the fragmented, incomplete approach we have taken toward health care, leaving only the insurers and the drug manufacturers as healthy, wealthy components of the industry.
We need to look at the forest. We have enormous resources in this great country, but they are being misdirected, confused, and diffused. Sophisticated information systems, thousands of nurses, countless thousands of administrative workers monitor insurance claims processing, sending bills with relentless efficiency, denying claims with speed and dispatch, while doctors’ offices, emergency rooms, laboratories and pharmacies barely communicate.
We have an accelerating nursing shortage, forcing hospitals to recruit talented nurses from all over the world to care for the sick, while here their colleagues are recruited away from the bedside to work for lawyers and insurance companies.
This is the forest. Our health care system is broken, the pieces lay all around, and directing our attention just to the pieces is doomed to failure.
This is the forest. We need a single health care system, a single payer for all services, a single focus for setting policies and priorities. It can incorporate all of the components.
We can use the enormous bureaucracy that has grown here. But it must be unified, prioritized, redirected toward delivering care, not paying for it. Clearly, this is an effort that would best be pursued by Congress and the national administration. But if not, then let it start in Connecticut.
Just by unifying the countless forms and applications, drug formularies and benefit plans, we can reduce the burden of administration that lies over health care, thereby freeing energies to address real problems, such as coverage for those now uninsured, and a systematic approach to medical errors. We need to do this now, for delay will only mean more pain.
Dr. Steven Wolfson is a New Haven cardiologist. Readers may write to him in care of the Register, 40 Sargent Drive, New Haven 06511.