The Five Dirty Words of Health Care Reform
Special to Roll Call
As a practicing physician for 30 years, I can readily testify that health care is in need of repair. It now appears that we as a society are finally ready to attack the problem in a meaningful way. I am fearful, however, of the way in which the present debate is being framed. Words matter, and when I look closely at the language of health care reform I see many problems. To make the health care debate honest and sensible, we need to remove what I would call offensive language. If we could just remove five words — five dirty words that are actually just misleading vulgarities — then the health care debate can truly begin.
Stakeholder
The word “stakeholder” is invoked at the beginning of every meeting on health care reform, punctuates the start of every Congressional committee meeting and is flashed like a picture of a grandchild at every press conference. However, most of these so-called stakeholders are pseudo-stakeholders. Megalithic hospital conglomerates, auto manufacturers, the government, or, God help us, health insurance companies are not stakeholders. There are only two real stakeholders in health reform: the patient and the caregiver. All health care funnels through them. They are the most important part of and the final common pathway for all health care delivery.
When you hear or read about yet another meeting of stakeholders, realize that 90 percent of those in attendance do not care for the sick and will never be at the bedside of a sick patient. The present health care system is rife with profiteers who view health care as a good business investment. Fancy hospital rooms, MRIs, endless billing codes, e-prescribing, new computer systems, etc., are all peripheral to the real business of healing. We must get the pseudo-stakeholders out of the way.
The most dangerous pseudo-stakeholders are health insurance companies. They restrict patient access and try to regulate physician behavior, yet provide no value to the patient or caregiver. What do the insurance companies do except take profits and deny patients treatments and access while drowning the physician with paperwork and meaning codes for diagnosis and treatment? Do they make us safer or healthier? Almost no one believes that. A recent USA Today/Gallup poll asked Americans who they trusted to make health care changes, and physicians were ranked the highest while only 4 percent trusted the insurance companies. If 96 percent don’t trust you, you are not a stakeholder; you are dangerous.
If we protect and preserve the special intimate relationship between the ill patient and healer, we will go a long way to “fixing” the health care system and cutting costs.
Coverage
Coverage is not care and should not be the goal of health care reform. Just ask the vast majority of Americans who have insurance coverage but who are not able to get access to medications, procedures or their caregiver of choice. Many studies show that even patients with coverage are paying increasingly high deductibles and percentages of charges for less care, less access and increased hassle. A Consumer Reports investigation revealed that insurance plans are so riddled with loopholes, limits and exclusions that if a patient falls seriously ill they are often left with crushing medical debt even though they have coverage. Coverage has become less for more — less care for more cost. Forcing the insurance companies to lower their premiums will not solve the problem. They will only pass the loss on to patients by providing even less service.
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