Healthcare Reform from a Primary Care Perspective

I haven't written on my blog in quite a while. There are several reasons for this, but I will avoid listing them to prevent your boredom. However, I have come across a recently published book that has struck me. America's Bitter Pill by Steven Brill is (so far) an excellent book that looks at the politics and policy of recent attempts to fix our healthcare system. As a practicing physician and also a consumer of healthcare, I wanted to highlight some of the statements he makes and occasionally make personal comments. I am in no way an expert on healthcare economics, public policy, or politics. My comments are simply observations from more than twenty years of caring for patients and helping them navigate the healthcare system. Many statements are anecdotal and not backed by science. In advance, forgive my tendency to get on my soapbox. I can be extremely passionate about some things. 

• "Healthcare is by far the nation's largest industry, employing one-sixth of the workforce."

• "People care about their health more than they care about healthcare policies and procedures." - I know that when I talk with a patient that has a condition similar to something I (or a family member/friend) have experienced, my counsel is much more appreciated. 
• "60% of personal bankruptcies result from healthcare costs."
• "The US ranks 31st in the world in life expectancy and 28th in infant mortality. This is despite the industry being so large."
• "In 2010 the average healthcare policy for a family cost $11,841- one thousand dollars more than one makes at a minimum wage job."-  This is completely in line with the average healthcare expenditure per patient. I am amazed by this when I consider that there are a lot of young, healthy people out there who spend very little on healthcare and then older, more complicated (more "ill") people spending a lot more than this. To use round numbers, someone (either you, your employer, the government, or some combination) is paying ~$1000 a month to be sure you have access to healthcare when you need it. 
• "England's Healthcare spending as a percentage of GDP is one-half of the US but the results are significantly better."
• "Adverse selection (people only buying insurance when they need it) would cripple the system." Therefore a mandate is necessary. - Without requiring everyone to purchase healthcare insurance, younger, healthier patients would "fill out their insurance applications on the way to the emergency room". 
• "Medical costs increase by the equivalent of one Iraqi war per year."
• "Romney's three legged stool (no denial for pre-existing conditions, mandate for all to have coverage, subsidies to help those who cannot afford coverage)" was well-designed.- This plan seems to have worked in Massachusetts and was the foundation for the Affordable Care Act. However, during the politics of policy-making, many of the foundations necessary for it to work on a national level were changed by (who else) "special interest" groups. Not all, but most of these changes, decreased the chance for the reform to smoothly transition into the national platform.
• "Containing costs is more difficult than increasing coverage (cost containment means cutting someone's revenue flow)." - Both will be required for it to work.

My comments on Steven Brill's America's Bitter Pill.

I will update as my reading and thinking progress.

rdl