My perspective on health care reform

(previously posted on ICSI Healthcare Blog)

Even though any health care reform that may be passed after the current debate will affect my generation and those that follow the most, it seems no one is asking the young what they want. I feel I have no control over the end results. Maybe people think we are uneducated about health care and don’t understand the issues. Maybe we are not invested enough in the issue. Maybe they think we are still too inexperienced in life and do not know what is best. Or maybe we are considered too idealistic or that what we want is major reform that could shake this whole country upside down. But young or old I think we can all agree we just want a better health care system.

So who am I? I am a graduate student in the Health Communications MA program at the University of Minnesota working at ICSI as a summer intern. I have spent two years learning about the problems in our current system and the entire summer learning about some possible solutions. I am constantly reading online newspapers and blog posts from some pretty smart people who know their stuff. Now that does not mean I know the solutions, but I have an informed idea of some things that need to be changed.

Oh but that’s right, I’m young, so what do I know? I know that we cannot leave it up to aging politicians worried about next year’s election to make the right call. I know we cannot allow any lobbyists to be involved near Capitol Hill during the debates. I know that we need better health reporting, so the public can be educated on the complete problems and solutions with an unbiased tone. Just tell the facts.

I think that we need to use electronic medical records or personal health records to help standardize care. We cannot rely on memory alone. We need a system to ensure the appropriate ordering of evidence-based diagnostic imaging tests and a way to decrease medical mistakes in hospitals.

I think we need a way to end defensive medicine—not only in reforming malpractice lawsuits, but also changing the way Americans think about health care. More is not necessarily better, and we need to find a way to change that perception. It is not easy to change a culture but we can try. While we are at that, we need better health journalism. Why are Americans confused about health care reform? Ask your local television news station.

If we want our doctors to practice evidence-based medicine, then we need to include patients in the process. Shared decision making puts the patient in control of their health and gives them responsibility and accountability for the end results. Providers present the information for all the treatment options so the patient can weigh the risks and benefits according to their own preferences. When a patient is presented all the options, studies show that they will pick the least costly and invasive procedure (http://online.wsj.com/article/SB10001424052970203674704574328570637446770.html). In addition, health literacy is a real problem in this country, but shared decision making tools and videos help make the medical terminology easier to understand and help the patient pick an option that best fits with their values, which can help increase compliance and comprehension.

I think doctors should be on salary. In some industries, it makes sense to have a pay-for-service system in place, but for health care, I find that to be morally wrong. If this pay system was gone, we could have more coordinated care and patient appointments would not always be tied to an office visit. Doctors could converse about a patient and know that their time is being reimbursed. Nurses could do weekly follow-up calls when difficult cases present themselves. We could have a medical home system in place.

Lastly we need to support the value of primary care physicians in this country and focus on preventative medicine. Growing up I had a great doctor I saw every year for that annual check-up. I was naive to think every American had the same care. I think we need to build incentives for medical students to return to primary care and increase how much they are paid to help primary care doctors pay back their debt quicker. Plus we need to end the 15-minute or shorter appointment slots that the current fee-for-service system drives. Not only do doctors feel rushed, but also patients are unhappy. (This may be a contributor to why patients feel like doctors are not listening to them and doctors are forced to practice defensive medicine.) By focusing on preventative medicine, we can control chronic diseases like diabetes and work to make Americans healthier and not just intervene with drugs and expensive surgeries.

None of these changes will be easy, but if we want a sustainable system that will not crumble again in 20 years, we need to do this. I know I am young and inexperienced, but according to all the evidence out there, we need some major changes in health care. Any real reform will dramatically affect every industry and every individual, and maybe that’s what we need. Shouldn’t we change health care for the greater good? Shouldn’t we continue to strive for excellence in quality and care? Do we want our system to be ranked 37^th in the world, forever? Or am I being too idealistic again?