Rae’s Sure Fire Plan…

So here is the rest of my eight point comprehensive plan:

4. Make it alright for people to die – We have a problem with death here in the United States. We overwhelmingly reject it, even when it is for the best. The human body can be sustained long after the patient is gone, and often is. Sometimes this leads to pain that can never be adequately treated and existence that is not life. I am not suggesting that we need to have death panels, but I do believe that physicians should be able to have intelligent discussions with patients and families about the quality of life of the patient and be able to act on these conversations without fear of criminal prosecution.

5. Increase the use of mid level providers – One of the biggest problems that we have here in America is that there are not enough mid level providers. I work with some every day and they are wonderful. Most are careful, committed clinicians with focused skills that provide good service. Here is the rub. We have allowed discussions about who should be paid what to reduce the effectiveness of the use of mid level providers, in some instances. There is room for both – physicians and clinicians that are supervised by physicians; the combination is the best approach because it expands the quantity and quality of care that can be provided. It is difficult to become a physician. The training is long and the requirements for practice are many. It is easier to become a mid level provider. The training is not as long and the requirements are not as arduous. Both have a place in the care of Americans.

6. Change the liability equation – We must change the way we deal with incompetent doctors and with bad outcomes. Many times there is no relationship between the two. Some very fine physicians that care deeply for each and every patient have had bad outcomes with patients. The public is sometimes lead to believe that physicians and nurses are all incompetent and should be punished for bad outcomes. I reject that notion, largely because I  live in the healthcare world and I see people working very hard everyday to make people’s lives better. When bad outcomes do happen, maybe we should have a professional panel made up of experts that could determine if there was “fault” on the part of the system that was taking care of the patient. Subsequently, ongoing costs of rehabilitation or care could be assigned to the patient without having an adversarial confrontation.
We must change this because it is a substantial part of the economic equation. The adversarial system raises costs!

7.  Tax things that make people sick – The costs of cigarettes to our economy is far in excess of the amount of tax that is received, both at the federal and the state level. Cigarettes provide us with excess lung disease, heart disease, and cancer. The equation that defines the cost of these diseases can be calculated. That number should be the basis for the tax on cigarettes – the real cost of cigarettes to the economy – and my guess is that is in excess of $10 per pack.

8. Outlaw handguns – I am sorry NRA. From the perspective of a health care provider, this is a no brainer. I have never taken care of a patient that had been injured with a gun that was happy about it. I have never encountered a child that had shot themselves with a parent’s weapon that was better for it. I have seen many people that were shot with their guns and most wished they hadn’t had them.

So there it is, my “Sure Fire” Plan. Guaranteed to reduce the cost of healthcare for everyone so that we can afford adequate care for all.

Rae Brown, MD

Rae’s Sure Fire Plan to Reduce the Cost of Healthcare

Our current expenditure for healthcare in the United States is staggering, but as I have said before, it pales in comparison to that amount that we spend to kill and maim. Some money spent for healthcare is appropriate; healthy workers are more productive and pay more taxes. The system can be much more efficient, however, and  as an insider I have some suggestions that would reduce the cost substantially without affecting quality and without “rationing”. This posting will take a while…stay with me!

These are the eights parts to the surefire plan:

1. Focus on wellness – We need to get up and move as a nation. It is almost a national emergency that we don’t expend any more energy than we do. This trend shows in increases in weight, diabetes, hypertension, and a variety of other chronic diseases including some forms of cancer. In addition, the AAP has recognized that the number of children that are obese is rising and as one might expect, so has the incidence of diabetes, hypertension and lipid disorders. These children will be sickly adults for a long time and we will pay that bill.
We need an extra hour of school for physical education, more biking and walking trails, incentives to walk or bike to work. In short anything which will incrementally increase the average expenditure of energy by Americans. This is the most important thing to reduce the cost of being sick: don’t get sick!

2. Reduce the cost of drugs for patients with public healthcare options. – The federal government could negotiate the purchase of 5 billion simvastatin tablets to treat abnormalities in cholesterol. Since one drug in this class is nearly as good as any other, getting this drug from the government for 5 cents a pill would save Part D of Medicare billions of dollars. Walmart has it right, they have a group of about 100 drugs that treat 99% of patients very well and they sell them to you for $4 a month. By the way, they make a profit.

3. Make the electronic medical record part of the national infrastructure. Our lack of ability to diagnose and treat patients because we don’t have the data that we need about trends in their conditions, what hasn’t worked for them in the past, what family history is germane to their management, and even what their allergies are has a staggering cost. We miss labs, double order, can’t find charts,  basically fly blind in bad weather with the sickest of patients.
A national medical record system will improve the quality of care that we can provide tremendously because it will allow clinicians that are intelligent and well trained to do what they should be able to do – make professional judgements about  the patients medical condition based on evidence without having to guess. Sure, privacy is important, but I am confident that the government that brought you the National Security Agency can figure out how to encrypt my PSA.

More tomorrow…Let me hear from you.

Rae Brown, MD