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Health Care Is Broken– Time for Democrats to Develop practical reforms, to Legislate, and Pay For, an Improvement both in the pay structure and the management of medicine

2019-04-04

 

The electronic medical record, or electronic health record, is an administrative nightmare that is contributing to the burnout of 78% of all doctors surveyed.  People are declaring bankruptcy as a result of medical bills; 40% of all bankrupts mention medical expenses.  Our life expectancy, infant mortality, and other vital statistics are getting worse, not better.  We lag behind numerous other developed countries in healthcare and spend twice as much as most of them for less result.

The problem with healthcare in this country is due to unrestrained greed on the part of insurance companies, pharmaceutical companies, hospital conglomerates, and medical specialties.  Every aspect of healthcare is infected with profit-taking enterprises.  Each interest in healthcare is represented by lobbyists in Washington and countrywide who push government and individuals to spend more.

To fight the greed of insurance companies especially, we will need to develop systems that gradually take over the functions of insurance, with some kind of buy-in by companies.  Insurance will have to change its emphasis from determining if a person is covered at all to co-ordinating the care each patient receives.  Companies will have to merge and pool their data.  Government will offer insurance companies contracts to manage the data stream.

Medical records must be forced to become available across all platforms.  Laws will need to be developed that manage information sharing instead of enforcing complete privacy.  In order to facilitate sharing, when you develop records in one location, consent must be given at the outset to share so that reports are automatically sent to other locations that provide care later, when the person appears there.  That is, initial consent documents must include a clause that authorizes data sharing on an as-needed basis later on.

One innovation that has made the adoption of electronic medical records easier is the addition of a “scribe” the the usual personnel in a doctor’s office.  This person follows the doctor around and transcribes a record of what the doctor reports and what is examined, including prescription and therapy orders.  Since the scribe is usually a medical assistant, the cost of the additional person can usually be justified by the improved workflow.

Most important, however, is to co-opt the insurance companies and get them to serve the needs of universal insurance rather than particularized (and much more expensive) plans.  The insurance companies have powerful lobbies to protect them from government action and they will need to be handled with care.  Plans for reform will need to include a role for the insurance companies even if their basic reason for existence– discriminating who does and does not belong to their particular plan– has been removed.

Finally, a radical idea has been proposed about drugs: the government could take over the production of orphan drugs, vaccines, and other items that are in high demand because of effectiveness but that present little or no profit potential.  Drug companies might be willing to trade production of unprofitable drugs by the government (a relief for them) for negotiations on price with Medicare (something they are afraid of).

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