LITTLE ROCK — With each passing day the goals of health-care reform seem to become harder to understand. As someone who has spent my life delivering handson, in-the-trenches care to thousands of older adults, I am convinced of one thing: We must improve health care or face dire consequences.
For every American - regardless of age - the "Graying of America" is the single greatest issue facing us. Seventytwo million baby boomers are marching inexorably toward old age. Which means that in the next few years, the Medicare-eligible adults (who utilize 65 percent of all health-care costs) will increase from 12 percent to 20 percent of the population. The over-85 population will increase by almost 200 percent, and half of these patients will be physically or cognitively dependent, unable to live alone, and generating enormous health-carecosts. Without a major overhaul of our health-care system, we will not have enough money to pay their health bills.
But back to the finances of health-care reform. If we successfully insure every American in the nation, the total costs of health care will absolutely increase. Couple a larger insured population with an ever-growing group of older adults and the health-care costs could cripple the economy. So, herein lies the question on everyone's mind - how do we pay for it? With increased taxes? More prevention? Budget cuts elsewhere? While all of these solutions are certainly up for debate, the easiest way to control costs, cover the added expenses and effectively create a "budget neutral" solution is to practice more of the right medicine and less of the wrong. Convince Washington to focus on health-care delivery and we can solve the health-care crisis.
The problems with the delivery of health care are multifaceted. First, there is a most serious manpower problem. The average primary-care physician is over the age of 55. And, as we begin to retire, there will be no one to take our place. We must create incentives to reverse this trend. In order to accommodate the health needs of Americans, at least 80 percent of new physicians must become primarycare physicians. But in order to do this, we must make primary care more attractive.
Primarycare physicians should be paid on the quality of their care - and the health outcomes of their patients - rather than the sheer number of patients seen or procedures performed.
Second, we have a problem with the quality of care. Americans spend more per capita on health care than any other developed nation and yet our health status ranks almost last. As much as half of the $2.6 trillion spent on health is unnecessary, inappropriate and unnecessarily expensive. The most aggressive, expensive care is not necessarily better than conservative, cheaper care. For true health-care reform, Washington must help physicians make low-cost, evidence-based, rational decisions.
Rather than driven by quality, it is the bottom line that frequently affects treatment plans. We order too many tests, perform too many unnecessary procedures and prescribe thenewest, most expensive therapies. The evidence is compelling that in many circumstances much of what we do is of no value. To avoid any misunderstanding, we must all become more educated and empowered. Make sure you understand your illness, the benefits and side effects of a proposed treatment plan, examine the scientific evidence proving the treatment is of value and assure that the treatment is best for you. It is not about rationing. It is about more of the right care and less of the wrong unnecessary care.
In thinking about health-care reform, please remember that it is all about the doctors. Doctors order all the tests, perform the procedures and prescribe all the expensive medications. Stop unnecessary care and there will be more than enough money to focus on the disease prevention, better health and a longer-lived, more independent population.Give physicians the leeway to focus on what is right and effective rather than on the bottom line, and we can return medicine to its rightful place as a noble profession. But leave the doctors out of the equation and no amount of health insurance reform will matter.
Dr. David Lipschitz is the director of The Longevity Center at St. Vincent Infirmary Medical Center. More information is available at: www.drdavidhealth.com
High Profile, Pages 37 on 08/23/2009