Well, I don’t think there should be provisions that completely obliterate drug companies incentive to explore and create new drugs, as we are the leading country in doing this now. No other country holds a candle to us on this.
I don’t think we want to quit marching forward creating cures for cancers, heart disease, and the severe chronic illnesses such as lupus erythematosis, multiple sclerosis, systemic sclerosis, amyotrophic lateral sclerosis, or of the many heart-rending health disorders in children, including congenital abnormalities.
But, the drug companies’ pricing bears a some looking into. And we should insure that there is competition between them, and not make the term of exclusivity (where other companies can’t make copies of the drug and sell them) so very long as to overly reward and enrich them at the expense of the public.
Something should be done about “self-referral,” where a doctor owns his own cozy little lab, CT Scanner, MRI, and thinks of every possible excuse why the patient needs that study. And, of course, we should continue to outlaw fee-splitting – where a surgeon gets referrals by giving a kickback to the referring GP, who may not be able to even decently hold a surgical retractor, while he “helps” the surgeon operate.
Malpractice suits of some sort should be kept alive, but there should be some sort of “cap” on them, so someone can’t sue and win a trillion dollars over a needle left in their butt.
Some system, where there are “no-fault” awards for poor results that no one could avoid should probably be included. There ought to be some sort of “small claims court” where non-rich patients could bring their case and get awards, without a lawyer making a humongous amount, so the patient can get a pittance.
If a person incurs an injury where it is going to cost about $1 million over the rest of his life to care for him, there is no reason the lawyer should get inflated costs up front plus $400,000 dollars of the $1 million dollars awarded if the case is won. Now, this is often the case.
Many more people should probably be covered in some way by insurance, whether by a company or the government. This would mean forcing 20 year olds, who think they are immortal and refuse to buy insurance, to get some minimal insurance, at least. And have catastrophic insurance included so if someone contracts AIDS, or has a brain injury, that will cost over a hundred thousand to millions of dollars during his lifetime. This should be covered.
After all, the rest of will pay for his care if he doesn’t have insurance (hospitals now bill us to cover their losses on those who don’t pay), so I think he is obligated to carry some of the burden.
Although it attacks the general concept of insurance for cars and pine beetles, or whatever, companies should be forced to cover everyone, and not disallow claims and insurance for pre-existing conditions. As it stands, if insurance companies don’t cover them, you and I will. If they are all placed on an equal footing, they should not complain.
To say that people aren’t covered is not quite true, as I have spent my life taking care of indigent and poor people. I have more than once helped in the spending of over $1 million dollars on a single patient who had catastrophic injuries, for example.
When someone presents at the emergency department as an emergency, we are obligated to treat and do. They might be temporarily turned away from a for-profit hospital if they are not in dire straits. But some hospital in the city (like Denver General) will take care of them.
In covering indigents living under viaducts, like some of my patients in Denver, this would be cheaper than always waiting for their illness to get so severe that they have to be treated as an emergency. And it is better for the people. And if they are even partially employed, some of them can remain employable.
This is also true of illegal immigrants – including them under some sort of umbrella insurance before their medical condition becomes dire and they present as emergencies would be cheaper for the country. And it would be better for their health; however, realistically in the present political climate, I don’t this can be enacted into law. And so I would leave them out of any bill of “universal, or near-universal insurance”.
I have observed the Swedish socialized brand of medicine first hand for two weeks, and I have close friends and acquaintances who have experienced, or worked within, or have been associated with Canadian and English socialized medicine. I feel there are serious deficiencies and inequities in these three brands of socialized medicine, but they do achieve broader coverage of the populace.
I have seen where the phenomenal fantastic promises of the politicians lead the public to believe one thing in those countries, and then quietly and clandestinely they cut back on funding to save money. This creates numerous problems.
At the medical conference at Big Sky Montana, I saw the Canadian doctors report on doing procedures in a fashion that was considered two generations outmoded in the U.S., and had I adopted their methods, I would probably have been sued by some alert lawyer.
I found some 5 interludes of delays in the treatment of one of my little cousins in Sweden as they slowly and gradually kept bumping her up to the next echelon of medicine, until she finally received superb care, but somewhat too late. They asked my opinion, but I side-stepped the issue, since I felt my interference could only exacerbate the problem, and cause further delay.
I don’t think their will be any boards in the immediate future that will just let poor old Grandpa die to save a buck, but I think in the more distant future as the ratio of working men and women continues to decrease relative to the elderly population, some sort of “benign neglect” may well be instituted for the chronically ill elderly (perhaps by 2050 or later).
Will the best and the brightest still try out for a place in a medical school if they are to become mid to low level civil servants in a faceless bureaucracy? Perhaps, and perhaps not.
We already have some of the sharpest people focused on getting into a profession of legal shenanigans, or moving money around, and creating their own wealth above all else. Rather than setting out to be Henry Fords, Thomas Edisons, Jonas Salks, Albert Sabins, Albert Einsteins, Bill Gates, Steve Jobs, and such people, who use their inventive minds to actually create wealth, make the world a better place to live in, and advance mankind in the Arts and Sciences.
The monetary rewards for being a talk show host whose job is to entertain and waste people’s time, or for becoming a “star” like Michael Jackson, Madonna, Peewee Herman, or for becoming a “public servant” and serving a term in congress, then in retirement make 100 percent of your overpaid salary until death, are much greater than the monetary rewards for becoming a GP or Specialist (and having done your 23 years of study in sackcloth and ashes at a monk’s salary, and actually paying out money most of that time).
In my own experience I have “ridden a circuit of little towns” in South Dakota, practiced in private offices, in Johns Hopkins, Duke, and George Washington universities, in the military both in the U.S. and overseas, in the VA, in a Kaiser office and the downtown San Francisco Kaiser hospital, in San Quentin Penitentiary. And I have done a little personal outreach to rural Moroccans while I lived in that country. I have studied, taught, or practiced medicine, or some combination of the three, in South Dakota, Pennsylvania, Maryland, Washington D.C., North Carolina, California, Colorado, and Texas.
Delmar H. Knudson, M.D., lives in Denver. EDITOR’S NOTE: This is an online-only column and has not been edited.
