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the blog

Tuesday Mar 31, 2009

Serious Healthcare reform (part 1) - Where to start?

I'm still waiting for the debate to start. When are we, as Americans, going to get this debate started? Dem From CT has tried. He has posted some thoughtful information and questions on healthcare. Yet he has not drawn the type of overwhelming responses that would suggest that progressives are engaged.

Well, let me try to get this puppy started. Over the next several weeks, I will post a series of articles that will examine healthcare as completely as I can.

As a trauma surgeon, I bring a unique perspective to this discussion. I see all types of patients. Rich, poor, young and old. Everyone can be a victim of trauma.

So, is healthcare a right? I know that this starts arguments but it is time to have those discussions. This question is important because depending on your answer, it will change our approach. Let's look at both sides of this argument.

Yes, healthcare is a right. When Thomas Jefferson wrote "life, liberty and the pursuit of happiness," it was as if he was including Health. It is as clear as the nose on Jefferson's face. If healthcare is a right then all Americans should be given adequate healthcare. This healthcare should be guaranteed by the state.

On the other hand, there is no way that Thomas Jefferson or any of the founding fathers thought about healthcare because doctors in the 1700s really didn't do much. It is hard to put words into the mouths of our forefathers. So maybe healthcare isn't a right. Maybe it is a privilege like driving a car.

I have no idea how our economy is going to grow if a significant portion of our workforce is worried about their health or have their finances tied up in health care. As we get older and work longer there are going to be more health issues in the workforce. Diabetes, hypertension and obesity are terribly expensive.

We've all seen the numbers and they are staggering. $2.1 trillion! This is a total pricetag of healthcare in the United States. We spend approximately 16% of our Gross Domestic Product on healthcare. Germany spends 10.9%. France, a country that many conservatives paint as a welfare state, shelled out only 10.5% of their Gross Domestic Product.

So, we're spending a lot of money. A ton of money. I would argue with critics who say that healthcare in the United States is terrible. I think this is a complete distortion of the facts. Instead, healthcare in the United States is very spotty. Some people get excellent care. Some people are overtreated and others are undertreated. Now, we can point fingers at who's to blame for those who are overtreated and those who are undertreated. We do know one thing for sure and that is 47 million Americans go without health insurance. It is almost a sure bet that many of these Americans are undertreated.

Let's look at a very common scenario. As I tell this story, think about overtreatment and undertreatment and about the delivery of healthcare. Again, is healthcare a right or is it a privilege?

A 25-year-old male works as a stock boy at Wal-Mart. He's never been to the hospital. He does not take any medications and he is healthy. He carries no insurance. While in the warehouse, he turns around quickly and hits his head on a metal pole. He is a little dazed but is not knocked out. He develops a bruise on his forehead. He asked his supervisor if he can go to the doctor. The patient presents to the emergency room complaining of a headache. The ER physician takes a thorough history and physical and only finds a bruise on the patient's forehead. The ER physician orders a CT scan of his head. This scan is negative for any traumatic injuries. The patient is sent home with instructions to return to work as soon as he is able.

So? What do you think? 30 years ago, a patient with such an injury would not go to the emergency room. 20 years ago, the standard of care would be to examine the patient and if the patient does not have any specific signs of a head injury like nausea or vomiting, blurred vision or decrease in mental status then the patient would be sent home on aspirin or Tylenol. 10 years ago, because of the availability of CT scans and the wealth of information that physicians can get from CT scans almost all head injuries get scanned.

So what are your thoughts? Is healthcare a right? We have a golden opportunity to fix this system so that it works for every American. Let the great healthcare debate begin.

Posted by Errington Thompson on Mar 31, 2009 email post email Spotlight / / You are in Health Care