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| How we get there from here | ||
By Walter Tsou, MD, MPH
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Robert Corrato asks two questions which deserve a response.
First, the implementation of a national health insurance plan is not a substitute for a
public health department. There are many public health functions which would be
implemented such as community needs assessments, environmental and communicable disease
control, community health policy development and evaluation of programs, which are basic
to any public health infrastructure and are separate from financing medical care. Indeed,
a national health insurance program can greatly improve community health by providing true
population based data which more accurately reflects the health needs for a community. However, it is true that my role as a public health physician could change, both geographically and in responsibility under a national health program. I would welcome such a challenge. Indeed, as much as I enjoyed caring for patients when I was in practice, I find it difficult to want to enter private practice in this current environment. Not surprisingly, a properly financed national health insurance program is the only financing plan which would compel me to consider returning to private practice since my first concern would be toward patient care, not insurance status. Your second question is more challenging, but important. What concrete steps can we realistically take to get there? In our current conservative climate, any action is viewed with great suspicion. Indeed, I fear that there are a limited number of proactive, but important steps that we can take. Unfortunately, the answer may have to come from the ashes of the destruction of our current health care system. Already, we are seeing the seeds of disenchantment growing among physicians, hospitals, and health care professionals. On December 3, 1997, JAMA will publish a five page Call To Action signed by over 2,000 physicians and nurses. We expect thousands more will sign over the next few months and increasing endorsements by medical societies. It is my hope that physicians and health professionals will play the key leadership role over the next decade in redirecting health care. Second, patients are increasingly disenchanted with for profit medicine. As we age as a population and as the number of uninsured rises, there will be political pressure to improve both access and the quality of benefits provided. Tinkering with a flawed system will not be acceptable. Third, and perhaps most important, for-profit medicine will slowly fail at its most important advantage, namely reducing insurance premiums for employers. Already, major HMOs have lost money and will either implement more draconian restrictions on benefits and payments and/or raise premiums. Stock prices will fall and many HMOs will follow Prudential and sell their health care units to others. As employers are faced again with rising premiums and fewer choices, they will have to revisit whether a stronger role for government financing would not make economic sense for them. Finally, these changes have already begun and will force wrenching changes over the next ten years. As we witness the destruction of what we hold dear in medicine, I believe physicians, politicians and employers will revisit national health insurance. These next few years will become a series of stopgap measures aimed at plugging a leaking dam, but as more holes spring open, we will be moving into crisis mode. As difficult as it seems today, I believe politicians, employers, and physicians will resign themselves within the next ten years to the only logical solution - a properly financed national health insurance plan which will sadly sew its roots from the remnants of what we once viewed as greatest health care system in the world. My commentary was written to recognize the inevitable, plan wisely, and create a strong health care system without destroying it. It is still possible, but time, vision, and leadership is needed now more than ever. |
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