New Approach to Health Care Reform

One of the Google Alerts to which I subscribe is "health care reform," which seems to offer the liveliest discussion of late of any topic I subscribe to. For obvious reasons, of course, what with our incoming president putting health care on the top burner (right below economic stimulus, I would imagine). Everyone in what I read seems focused on how to maintain the current system of private insurers and private medical practitoners while somehow incorporating another 47 million people into the ranks of the insured. However, as students at the Harvard Business School pointed out in their blog, where are the doctors going to come from to handle these millions? They describe how, even in their home state of Massachusetts, getting everybody insured is not the same thing as getting everyone in front of a doctor. The American Medical Association (AMA), they note, paints the current physician shortage in the U.S. at between 35,000 and 40,000 practitioners. That's number one. Number two is even more interesting, and it concerns the medical delivery system itself. I'd never really thought about this aspect before, until I read an article in the Anchorage Daily News. In that article, Dr. Doug Eby, a senior administrator with the Southcentral Foundation, which runs a medical center in Anchorage for native Americans, compares the current system to car repair: Come in, be diagnosed, get your fix (pill or procedure), and get out of my face until you break down again. In reforms carried out by Southcentral at its Alaska Native Medical Center, Eby and others have changed the whole focus, so that patients are now considered "customer-owners," and they don't necessarily see a physician for every complaint or symptom. They see whomever is most helpful and attuned to their situation. For instance, people with diabetes (after the diagnosis by a doctor) will work with a nutritionist and perhaps a behavioral counselor or other people who can set up a diet-and-exercise program and then monitor it to ensure its success. Also, everything is contained within the one facility, so that customer-cowners can walk from the nurse's or doctor's station over to the x-ray room or blood lab. Everything gets done at once. The results have been fairly stunning. In the ten years since the Alaska Native Medical Center has adopted this new delivery system, emergency room and urgent care visits are down by 40 percent, specialist visits by 50 percent, and hospital days by 30 percent. Efficiency and a more holistic approach seem to be paying dividends (although no one mentioned any proof that people are healthier or that the mortality rate is down). I think Dr. Eby and his colleagues are onto something big here since a lot of what ails us we bring upon ourselves by unhealthy life choices (smoking, eating too much and too much of the wrong things, not exercising, and the list goes on). Maybe number two--changing our approach--will mitigate number one, a shortage of doctors. Somehow, however, I can't see the politicians in Wsahington, D.C., being anywhere near smart enough or caring enough to consider something like this. They'll do whatever gets them the most votes, and then drop the whole system on a bunch of bureaucrats to run. Business as usual in the nation's capital and in medical centers everywhere. The lines and the waits will just be longer, much longer.