The Medical Care Crisis
For doctors this is the best of times, this is the worst of times. We have futuristic technology and modern medications allowing us to help our patients to a degree far beyond our previous abilities. Yet our medical system is breaking down so that we may not be able to deliver this high quality care to our patients in the very near future.
Nevertheless, this is the best of times for insurance companies. In 2005 the U.S. spent 16% of its gross national product on medical care while all other developed countries spent 9%. Where is this extra money going? One major area of extra spending is administrative. This overspending is not, as is often supposed, by Medicare which spent only 3% of its 2002 budget or by Medicaid which spent 6.7% of its 2002 budget on administration. It is the private insurance companies which spent 12.8% of their 2002 total revenues on administration. Would it be better to have a single-payer system with lower administrative costs (basically the government)?
It is rapidly worsening times for patients and employers. Out-of-pocket costs are rapidly increasing for co-pays, medications, and hospitalization deductibles, while insurance premiums increase yearly in double digits. This amounts to de facto rationing of health care; that is, people with less money must forego various forms of medical care. Would it be better to institute a planned, fair means of rationing as we realize that medical expense cannot be limitless?
Times are desperate as usual for physicians who must devote more and more time to the requirements of insurance companies, legal regulations, hospitals, nursing homes, home health agencies, credentialing agencies, malpractice carriers, government regulations, and many others. As a result, there is precious little time to devote to our patients, and yet it is time with patients through which the mystery and art of medicine arises. Do we prefer our physicians to be technicians devoid of original thought and feeling?
Is it a surprise that satisfaction levels of patients and physicians in our medical care system are low? I believe it is time to make the fundamental changes in our health care system that would preserve the quality, compassion, and equality of that system.
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