Friday, April 03, 2009

Pre-existing condition of being human

This article by syndicated columnist Ellen Goodman from yesterday's Washington Post gives a nice summary of what ails our current US healthcare non-system: "The Care in Health Care":
I was tickled to hear that the insurance industry is beginning to commence to start to think about lifting bans on the pre-existing conditions that keep a slew of Americans from getting health coverage. This has always been on the deep end of a pretty wacky system.

But there is a pre-existing condition that hasn't garnered nearly as much attention in the health care debate. It's the condition we all share: being a human being. As opposed to, say, being an organism subdivided into parts and scattered over the medical landscape from neurology to podiatry.

The current system makes it hard for people to get care for their whole body, much less their whole self (mind and body). The balance between splitters and lumpers has been tipped to the splitters by a wide margin for some time now.

Consider one of the least secret medical records in the country: the erosion of primary care doctors. A half-century ago, we had an equal number of generalists and specialists. Today there are two specialists for every generalist.

In clear view and with all undeliberate speed, we developed a system that rewards procedures over primary care. As analyst Robert Blendon puts it bluntly, "It's absolutely clear that payment systems have been negotiated that reward specialty time and use of equipment." The incentives tip toward the kind of medicine that is performed with hands, tools and technology over the medicine that is practiced with eyes, ears, and mind.

The average generalist now earns 55 percent less than the average specialist. Many students apply to medical school to connect with and take care of sick people. They graduate to become what one doctor slyly calls "proceduralists." They enter with a strong desire to look after families and exit with a ticket to X-ray femurs.
Read the entire article here.

She gets it. More and more people are finally getting the message that no meaningful healthcare reform will take place without fixing primary care first. And to fix primary care, you need to fix the system so that it will encourage, and not discourage, doctors from going into primary care. Otherwise we will continue to have too many doctors who look at you primarily as a body part rather than a human being.