Delay Healthcare Change
The demand to change healthcare is reaching a crescendo now.
I advocate an immediate delay in all such discussions.
Why?
Simple: Never, ever attempt to change a large social system until you are able to describe (in detail) how that system is organized.
Case in point: The U.S. Defense Department is enormous, but the Pentagon could easily draw a complete organizational chart starting with the Secretary of Defense at the top and the newest recruits in all branches of the armed services at the bottom.
No one in America has ever drawn up a comparable chart detailing our present system of healthcare. If they had, it would be very clear we have two distinctly different healthcare systems operating in America: federal and private.
No one has ever done it, yet multitudes want to change a huge system they can’t describe. That is a scary thought, but actually only half of the problem. Who does everyone assume will create this anticipated marvelous make-over?
The federal healthcare system includes Medicare, Medicaid, Department of Defense, the VA and Public Health. This consumes about 45% of the total healthcare cost. The private healthcare system (1 doctor/1 patient) is regulated by 50 state legislatures and DC and consumes about 55% of the total cost.
Though over 90% of all practicing physicians are in the private sector, they also treat the Medicare/Medicaid patients. Therefore, about 90% of the total cost of direct patient care goes through the private practice sector of our healthcare system.
Congress made a monumental impact on healthcare in America in 1965 when it passed Medicare. It has periodically continued to blur the line between the state and federal regulation of the practice of medicine.
What got lost in that blurring of lines? The entire healthcare quandary begins with one doctor and one patient and over 90% of all practicing physicians are primarily regulated by the state legislatures.
If Congress, or anyone else, wants fast results, let them begin by imposing a system of medical peer review within the Defense Department and/or the VA. There is already a proven track record of positive change in federally controlled healthcare. The Defense Department did it in the mid-1980s and the VA in the 1990s. Successful use of medical peer review within the federal systems would pave the way for state legislatures to follow suit.
The practice of medicine is the least regulated economic activity in America. “Defensive medicine” is said to be the greatest cause of the constant rising cost of healthcare. To change this, there should be a dramatic shift in the regulation of doctors. When medical peer review replaces medical malpractice litigation as the primary system for questionable patient care review, costs will be lowered.