Wed, Jul

Grasping Health Care is Like Grasping Water...Yet We Must Try


THE DOCTOR IS IN--We live in a nation that has been confronted with "experts" who think they know so much but actually know very little.  So if you think you have all the answers, or are looking for all of the easy answers here, then maybe this piece just is NOT for you.  


But at least, as a physician, I'm adhering to the time-honored and tested principle that the more one learns, the more one realizes that one knows frightfully little.  As with human nature, the differences between men and women, global warming/climate change, and the Universe in general, the opinions abound but the facts are elusive.

Very elusive.  Including and especially what to do about all that ... and including health care.

Issues of health care have been led astray by a variety of competing and unanticipated issues.  Medicare/Medicaid costs used to be much lower when people with illnesses such as diabetes and cancer just died quickly without being able to do much about it. 

Life expectancy, expectations, and quality of life were all undeniably less, so costs and health care operations were also less.  Furthermore, health care was a calling, and not an industry.  Yes, there was money to be made, but nurses and physicians gave it their all and often died on the frontlines of war and infectious diseases.

But something good happened.  Great, actually.  The potential and expectations of living to 70 years of age and beyond went way up.  People dying in their 60's is now considered dying too doggone young, and a real tragedy.

Unfortunately, we've not thrown more money and resources into our personal lives, and we've not established systems to maintain sustainable cost controls while pursuing the ability to do more for both the healthy and sick.  

The same can be said for those who forget that they will someday retire, and must put at least 10-20% of their hard-earned wealth to that end.  Or to get a second or third job to make sure they can live well while young, and to live with dignity when they retire.

So Congress is again debating health care, and politicians and special interests are doing the debating with front-line physicians, nurses, and other health care professionals being relegated to the back of the room, if being allowed into the room at all.

Many reading this, and many Americans in general, have not a grip or a clue that …

  1. health care access and health care insurance/coverage are two different things.
  2. there is a difference between a safety net and health benefits with all the trimmings.
  3. free or heavily-subsidized health care is administered to many Americans on a daily basis, including and especially by those accused of being greedy and heartless.
  4. getting insurance paid/subsidized by other people is NOT free.
  5. health care, as with retirement and other benefits, is an issue best dealt with by affirming one's own rights as well as responsibilities.
  6. lower the legal and financial costs of running a medical business is inevitably contributing to the explosive costs of health care.
  7. Americans pay 2-3 times as much for their prescriptions as European nations and Canada, and that American taxpayers' expenditures on health care and defense subsidize the rest of the world that is so enlightened and with "free" health care".
  8. throwing more money into health care, and guaranteeing coverage for all, can create a perverse incentive for pharmaceutical companies and medical device industries, to raise their costs explosively.
  9. laws are in place to require private health plans to allow appeals of patients and doctors for higher cost medications and procedures, but the ability to appeal government-run and single-payer health plans is frighteningly less.
  10. the consensus for removing health plan insurability for individuals with pre-existing conditions, and for allowing individuals to stay on their parents' health plans until their mid-20's is pretty much established, and no longer up for debate.
  11. the greatest reason for rising health care costs is the expectation by those who, more often than not, do not wish to pay more to get more...and not the doctors, health plans, and hospitals who are confronting the need to accommodate them.
  12. healthy, young but inevitably-poor Americans cannot pay more than $100-150 a month for their health insurance.
  13. neither the Affordable Care Act or the American Health Care Act are focusing on reducing health care costs.
  14. using the metric of direct coverage because of this act, or that act, of a federal or state legislative body or leader is NOT a metric that can be reliably used to determine the access--and therefore the likelihood of affordable health care AND/OR insured status.

So go ahead, and try to grasp and explain to the rest of us that you have all the answers for such a complicated subject.  It's like grasping water...you can try, but you'll probably fail.

But at least those of us who know we can't do it can at least throw out a few good ideas, working paradigms, and programs to let a few key economic and scientific principles run health care cost-effectively, while demanding that individual responsibility fill in the gaps that no one "expert" or "group of experts" can truly "fix".

(Kenneth S. Alpern, M.D. is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties, and is a proud father and husband to two cherished children and a wonderful wife. He is also a Westside Village Zone Director and Board member of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee. He was co-chair of the CD11 Transportation Advisory Committee and chaired the nonprofit Transit Coalition, and can be reached at [email protected]. He also co-chairs the grassroots Friends of the Green Line at www.fogl.us . The views expressed in this article are solely those of Dr. Alpern.) 


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