To create a solution for any complex problem requires that we identify, name, the problem so that we can approach argument about it with an intelligible focus. As President Trump has named “Radical Islamic Terrorism” to give a focus to a destructive chaos, so too I believe that health care has to be clearly defined to achieve similar precision. So far, politicians, who say they seek solutions for the American people, have been unwilling to do this. Note that by not defining health care clearly, politicians can hide behind rhetoric, false agendas which do not serve us but rather serve the interests of their lobbyists, and can kick the political football up and down the field while continuing to get reelected every so many years. To give some benefit of the doubt to the politicians, maybe what health care really is is not clear in their own minds like it is not really clear in our own minds.
What is health care? Define it! What exactly is it that is causing such turmoil in the USA, that occupies such a prominent place in the congressional legislative agenda, and that an entire business world has evolved to ostensibly support?
Please take a couple of minutes to think about and write down your thoughts about what health care means to you individually. It’s important for everyone to have a clear idea of what they’re arguing about or for, when they discuss American health care, which effort may help to bring their politicians to a shared precision about the quests of their anticipated legislation.
Health care is the DOCTOR-PATIENT RELATIONSHIP (D-PR). Frankly, that’s all it is. On an individual basis, it’s that individual relationship, and on a nationwide basis, it is the sum of all the individual relationships. What does this mean? It means, when you get sick, you go to visit the doctor and get yourself taken care of. To do that successfully, you must develop a trusting relationship with a doctor and vice-versa. Without that health care doesn’t exist. Think about it!
Over the last century, more or less, a chaotic system of business has developed, not to support this understanding, but rather to make the DOCTOR-PATIENT RELATIONSHIP a business product with various levels of service at variously increasing prices, which you can buy if you think you need it and can afford it. It’s a bit like one car dealership sells Cadillac if you want it, but another sells Chevrolet which should serve many of your needs. The problem with this approach in health care is that no one can ever accurately predict what they’ll need in terms of the menu of offered services. Moreover, what people really need, an equilibrium of trust in the context of a DOCTOR-PATIENT RELATIONSHIP, is not itself one of the offered products; it’s not even part of the vocabulary used in the rhetoric of the health insurance companies. Part of the reason for this may be that the nature of the functioning of the D-PR doesn’t allow it to be defined as a product like cars, houses, and all the other stuff we buy during our daily lives, sometimes taking loans out to do so.
So why do we tolerate a system which sells us quasi-health care, access to insurance covereage? Does our American health care system yield clear and equal access to sound, ongoing, non-conflicted, spontaneously functioning doctor-patient relationships? Ironically, “NOT ON YOUR LIFE!”
Politicians talk about access to coverage, which means you get to pay dollars in the form of premiums, deductibles, co-pays, and other dollar garnering mechanisms to obtain a limited, delineated health care insurance policy, which policy is not defined by a patient’s need, i.e., a D-PR which will accomplish the work necessary to diagnose and treat any illness, but rather defined by business derived, pre-determined calculations of costs for various illnesses and services, calculations designed to reap huge windfall profits for insurance companies by limiting what the policy will pay out and doing as little as possible for the patient.
America’s approach to a health care system has never really served everyone well, save perhaps for the Medicare eligible, and even they have problems in that people need a Medicare Supplemental Policy in case they get a catastrophic illness which Medicare won’t completely pay for. And these supplemental policies are expensive.
Nothing is free in America, we all know that. You pay for everything you get. Paradoxically, my solution for our health care system is to take the money out of it in regards to medical decision making, i.e., the doctor-patient relationship, since the proper functioning of this apparatus cannot lend itself to a dollar mentality, unless of course you’re in health insurance, politics, or health care administration, i.e., the world of quasi-health care, which needs it to function with a dollar mentality in order for them to stay in charge and justify their own ongoing existence.
HEALTH INSURANCE COMPANIES ARE SIMPLY NOT NECESSARY! In reality, they block the access to D-PRs for everyone by filtering out the people that simply can’t afford premiums, deductibles, co-pays, co-insurance, and other out-of-pocket expenses.
What the American health care system needs is a PAYER to administer payment of health care bills from a large fund of dollars provided by everyone living in America. Remember, the health care system doesn’t exist unless the people pay their dollars for it to exist. It’s the people’s system. I’m not sure how the insurance companies have come to the conclusion that it’s their system and they’re in charge.
R. Garth Kirkwood, MD