Patricia Salber
Posted 10/17/11 on The Doctor Weighs In
The 99% are mad as hell and aren’t going to take it any longer. They are sick and tired of Wall Street insiders getting richer and richer while the millions of Main Streeters keep on losing ground.
Today marks the one month anniversary of a movement that pundits initially thought had little chance of lasting. Instead of fading away, the Occupy protests are metastasizing across the globe with demonstrations in London, Rome, Chicago, Tokyo and even in Paraguay…Paraguay, for God’s sake. Some people are saying the Occupy movements are the “Arab Spring” of the West. People, empowered by technology, are refusing to accept the status quo that protects the interests of a few.
So how does this relate to health care? Well, right now, it doesn’t…but it should. Health care, in the US at least, seems to serve everyone well but the people who need it. For profit segments of the industry are by and large doing just fine. Insurers are raking in record profits – in part because utilization is down, many think, because of the recession. Doctors, primary care excepted, are probably mostly in the 1% or, if not, in the 5%. Device companies, drug companies, and other health care services companies – are making oodles of money.
But patients – the 99% – well, they are paying more, getting less, and waiting longer. Why the heck aren’t they mad as hell?
Some are, of course. If you didn’t get a chance to read Jane Gross’ terrific opinion piece in the New York Times, here’s the link. Even people with Medicare, like her elderly mother, end up destitute if they have the misfortune of taking a long time to die.
You rarely hear anyone saying America has the best health care in the world anymore. If they do say it, it is qualified: America has the best health care in the world if you have the money to buy it. It is within our power to fix what is broken – if we have the will. But that means the 99% will have to stand up to the 1% and demand a change to the status quo. It is not going to happen on its own – those who are profiting from the existing system simply have too much to lose.
- We need universal coverage – get everyone in the insurance pool so we eliminate cost-shifting related to the un- or underinsured.
- We need to get serious about waste. It is not ok to have our collective dollars spent on care with limited benefits (e.g., hip replacements in people with advanced Alzheimers disease or liver transplants for an alcoholic who is still drinking).
- We need to LEAN our delivery systems to make them more efficient and more affordable.
- We need to much more rapidly incorporate the new technologies into every day medical practices—why do we still have to make an appointment, drive, park, and wait for a 15 minute office visit? Technology is available now to transform many physical office visits into low cost, convenient virtual ones.
I could go on and on with potential solutions, but that would not be in the spirit of the Occupy movement. They are galvanizing opposition to the status quo, not proposing specific solutions…yet. I think we need to do the same in health care. Let’s agree IT IS NOT WORKING before jumping to a solution. We need every one who is, will be, or cares for a patient to first agree that there is a problem – a big problem – that has resulted in inequities that negatively impact the lives of folks every day – ranging from “job lock”(you stay in an unsatisfying job in order to keep your health insurance) to delays in care (not going to the hospital when you have chest pain, for example) to financial catastrophe (health care bills are the cause of ~60% of bankruptcies). Let’s get mad as hell and demand a health care system that serves the 99%. Occupy Health Care.
Pat Salber MD, MBA is a former Emergency Physician and large health plan Chief Medical Officer. She writes at The Doctor Weighs In.
Care And Cost 
I don’t know any doctor who believes the present system is problem free. Most believe the system is a mess. However it became a mess when third party insurers and regulators gummed up the system. Your solution of giving insurers more power in healthcare is like opening the door of the chicken coop to the foxes. It makes no sense!
All stakeholders have contributed to “gumming up” the system in their own way and many have something to lose as the healthcare industry experiences the same “flattening” that the rest of our economy has been experiencing for the last 10 years as it became global. If people are going to rise up for a cause in healthcare, I hope that cause is “the demand for greater transparency throughout the healthcare system”. Maybe John Lennon best said it when he called for “power to the people” (http://www.youtube.com/watch?v=Wos-dDxpJlQ)
The definition of “stakeholder” usually implies who is paying for the care. As the supermajority of care is not paid for by the patient, the “stakeholders” then become the government and insurers.
That being said, it appears we agree who has gummed up the system.
Remove the third parties from the everyday decisionmaking control of individuals healthcare and you will see greater transparency as the individuals will demand it. But individuals are scared and feel helpless trying to argue with either the government or the insurer.
If we include who is giving the care, the doctors and hospitals, I agree there needs to be more transparency. But that will only happen in a true free market system, not in todays dysfunctional one.
I agree with Point of Care Solutions. Everyone involved in health care helped create the mess we are in and it is going to take everyone (or almost everyone) to fix it. Contrary to what Doctorsh writes the insurers and regulators did not do this on their own. Do we need insurance reform?…of course…that is, to a great extent, what the ACA is about. Do we need to right-size regulation?…of course…we need to look no further than the FDA to understand that “lobby-able” regulatory bodies are in need of reform. We do need transparency as well and luckily there is already a lot of work going on in that arena. But we need other stuff as well (LEANing of business practices, alignment of incentives, real public health, etc.etc–there are no silver bullets in health reform, rather, it is going to take a thousand golden BBs.)
In my opinion, the oft repeated Republican strategy of repealing Obamacare is the wrong way to go. Does it need tweaking?…of course…all omnibus legislation needs to be continually modified as we learn more about its impact. But repealing it and going back the status quo…exactly how is that going to get us out of the mess? We have tried incrementalism in the past (post failure of Clinton reform)…it didn’t even slow the pace of deterioration of the system. Isn’t it time to take a stand that will help make it right for the 99%?
Doc weighs in:
I can play at this game as well.
Do you work in healthcare as a physician, and if so are you solo, in partnership, employee, or academic. Or do you work for a third party such as an insurance system?
I work in a solo family practice. The third parties are destroying healthcare by destroying the doctor patient relationship. There should be less intermediaries in healthcare, not more, unless you want to destroy the system further.
Obamacare is a travesty, and a government power grab. Individuals do know better how to obtain healthcare if you just get out of their way.