By Ryan McIntyre
Dr. Donald J. Palmisano, a past president of the American Medical Association, recently wrote that our country’s health care system “the finest in the world” and went on to say how a publicly financed health care system could ruin what has been built. He cites such potential horrors as long waits for specialists, bureaucratic intervention in medical decisions, and taxpayers bearing the burden of a government plan as reasons to oppose the creation of one.
I have one question for Dr. Palmisano: What country do you live in? In my country, America, we have the best doctors in the world. However, the system we have placed them into is stifling their ability to treat patients to the best of their ability.
Take wait times for specialists. We live in a country where 18 percent of the population lacks health insurance. This means that right from the start at least 46 million people have been cut out of the waiting line. Certainly this shortens the wait time for those of us with insurance, but at what cost in human life and health?
And if you want to go on anecdotal evidence, how do you explain the six-week wait I was told I had when I tried to make an appointment with an orthopedist for back pain?
How about the bureaucratic demons that are plaguing our doctors and patients now? Wait, aren’t these just called HMOs? Private health insurance in the U.S. interferes with the doctor-patient relationship all the time. Pre-approval for procedures, denial of payment, and pharmaceutical formularies – all of these are par for the course in the American health system.
According to the Commonwealth Fund, American doctors spend on average 142 hours annually interacting with health plans, at an estimated annual cost to physician practices of $31 billion, or $68,274 per physician. This works out to be about 3 hours per week. For primary care physicians the time is about 3.5 hours/week.
Now, Dr. Palmisano, if we divide this number by the average appointment time of 18.7 minutes, we see that doctors would be able to see an extra 11 patients per week if we did not have the administrative waste of our current system.
Finally, I agree with you that in these tough economic times, no one wants to saddle anything on taxpayers that they do not already pay. However, our country spent $2.4 trillion in 2008 on health care, with 46 percent coming from government money. This accounted for 17 percent of our GDP. The world’s second-largest spender was Switzerland, and they covered everyone by spending only 10.8 percent. We are already paying more for what we don’t get in the first place.
Our health system is wasteful and inefficient. I agree with you 100 percent when you say that reform should not weaken our health care. That is why I support a single-payer health program, like that in Taiwan, not Britain.
Taiwan spends only 6 percent of their GDP on health care, yet all their citizens are covered and get comprehensive, quality care. How do they do this? Simply put, they cut out all the administrative waste that is burdening the U.S. system. The government pays the bills, the doctors take care of the patients. It’s that simple.
The people there have free choice of physician, and the only thing that causes a wait time is the demand for the particular doctor. This is no different than trying to get an appointment with a high-end neurosurgeon here in the U.S.
Their system is publicly financed, but privately run. Were we to adopt such an approach here, very little would change in the work of our doctors except to lift from their shoulders the enormous paperwork burden that they presently carry. They wouldn’t have to worry about becoming government employees, for example, or told they can’t work in a given area.
Patients would have ultimate choice in provider. All doctors would be in “their plan,” including the one they are seeing now.
At the end of Dr. Palmisano’s article he asked, “Will we have a system that puts the patient in control with the doctor as trusted adviser, or a government-run system…?” My only response is: Why can’t we have both?
Ryan McIntyre is a second year medical student at Albany Medical College and an MPH candidate at SUNY Albany School of Public Health in Albany, NY. He is also a member of Physicians for a National Health Program. He can be reached at firstname.lastname@example.org.
By Ryan McIntyre