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Daily Archives: August 27, 2009

MassGeneralHospitalWhat’s wrong with the current system? Gross inefficiency, redundancy of services (generally lowering overall quality because the added programs lack adequate proficiency and don’t significantly improve access), irrational deployment of resources (i.e. too many specialists and too few primary care physicians, simultaneous physician gluts and shortages in different geographies, an excessive density of programs providing complex high cost care in some locations, a dearth of such programs in others), inadequate provision of primary care, psychiatric care, & translational care facilitating recovery once the patient is released from the hospital), increasingly arcane and inscrutable bureaucracy associated with fees and payments, antiquated processes (incomplete and disorganized medical documentation via pen and paper, versus (fully) electronic record keeping utilized by other countries), inadequate validation of processes, a lack of quality assurance, excessive negligence, inadequately investigated bad outcomes, inadequate trending and statistical analysis of outcomes, inadequate safeguards or remedies for negligence, runaway litigation, physician incompetence and impairment, inadequate regulation and/or control of insurance company practices, lack of adequate preventative or therapeutic care for the poor, the elderly, or children, a distorted focus on procedures versus outcomes, a failure to consider the whole person when treating patients, an inadequate focus on the psychological dimensions of illness, on the social and employment aspects of illness, inadequate mechanisms for addressing pain control, especially in terminal illness, inconsistent and arbitrary approaches to end-of-life-care (if you think your grandmother isn’t already refused adequate or compassionate treatment as an elderly patient, you’re sadly mistaken), inadequate recourse for patients denied choice or coverage, inadequate recourse for physicians or hospitals denied payment for indicated services or procedures. I could go on with the list, or expand any of these items in detail, but that would only add to the tedium of this already languid litany. I suspect most of the charges I’ve leveled will not sound unfounded or unfamiliar to you.

What is to be done? Obama’s initiative and what congress has done with it as a reform package is far from perfect and doesn’t begin to go far enough in terms of tinkering with the mechanics of very fouled up health care system. Nevertheless, it’s a lifeline thrown to a drowning person and if we are to have any chance of preserving our wellness—personal, societal, financial—we must grab it avidly and quickly. There is no chance the proposed changes will aggravate our predicament, and every chance they will improve it in manifold and significant ways. The plan will add to our choices as health care consumers, lower costs, and begin the process of trimming waste. The plan will also protect the uninsured (and the insured) from being without adequate coverage to manage catastrophic illness. In doing so, the proposed reforms will protect the rest of us from the high expenses to society associated with refusing to provide care when it is still timely and effective.

Beyond the plan we need a peer review system comparable to that used by NIH (National Institute of Health) which is run by the government yet is highly efficient, effective, and in fact as research systems go, is the envy of the world. Disinterested physicians, and other health care experts, (versus government bureaucrats) need to determine the appropriate use and deployment of finite resources. Simply pretending we can do everything when we know we can’t and can’t afford to (the ostrich approach) has to stop. We need to keep our insurance companies, but regulate and restrict them (like utilities) given their stewardship of a vital public resource. No longer can they be allowed to enrich themselves at our expense while pretending to “control costs” by denying us choice in what care we receive and from whom we receive it. No longer should we let them refuse to take care of us once we are sick. Of what use is health insurance that only insures the healthy? We the public need to make informed decisions about what happens to us when we are sick, such choice a welcome change from the current model in which we are kept in the dark as to the motives, workings, and impact of those taking care of us.

For José M. Hernández

The boy squatting with a wood and wire crate
In Salinas has finally risen
Above his station, California almost
Beautiful from this distance. Now when he bends
To the heavy glass he’s hurtling through
Vacuum cold as night on the desert
When coyotes bring the families across
In rust gnawed pick ups and then on foot.
He’s glossing over vast tracts of years, entire lives
In dirt and of dirt, obligations. He orbits
His parents talking low in their bed,
His mother’s sorrow the high pitch of rain
Against the hut’s metal blinds. In zero
Gravity the work is easy; nothing weighs
On the heart. He rides openly, needn’t hide
In back with shovels under a tarp.
The earth is no longer soil but rainbow blue
And round as fruit. His itinerant efforts pay back
In stars. Now heaven is mestizo, offers
Fine shades, not just Milky Way black and white.
Let the good news fall gently back to earth.
Let today’s harvest be measured not in pounds
But raised eyes, and miles, and light.

                                        –David Moolten

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