Last weekend we had a nice visit from my brother Paul and his wife Brenda. Paul is a paramedic with many years of experience and Brenda is an experienced Physician's Assistant, so naturally, one evening our discussions turned to the medical system in the United States. Hearing things from the professional medical side has convinced me that our system is more screwed up than even I ever believed.

Everyone knows that there are major problems with medicine in this country: many low-income people can't afford even basic medical care, much less treatment for major illnesses. Doctors and dentists don't always get fully reimbursed for their expenses, yet health care insurance is expensive and getting worse. I'll write more about this in a future blog entry, but here are some of the key points I see in the health care debate:

* Doctors undergo very long and very expensive training before they can practice, and they must continue to update their training each year, generally at their own expense.

* Malpractice insurance premiums are huge and, to me, represent a significant reason that medical care is as expensive as it is.

* Jury awards in malpractice suits are enormous. You don't have to be a rocket scientist to see a direct link between these awards and the skyrocketing cost of malpractice insurance.

* In order to avoid costly malpractice suits, doctors tend to be extremely conservative in courses of treatment, prescribing tests and examinations that may not be necessary for the sole purpose of being able to prove that they have done everything that can be done.

* The process of developing, testing, and approving new medicines is very long and very expensive; as a result, drugs tend to be extremely expensive (and the issue of huge jury awards in malpractice suits related to drugs applies, too).

* The ability of drug companies to advertise their new medicines leads patients to expect and demand prescriptions of new drugs from their doctors, whether or not these are the right treatment. The same applies to very expensive new diagnostic machines and treatments.

* The cost of medical care appears to be influenced greatly by the various lobbies that have a voice in the treatment we receive: the AMA (for the personal, professional, and financial interests of medical professionals); the legal profession (whose members have a vested financial interest in securing huge jury awards; and the drug industry (which spends huge amounts of money on developing new drugs and wishes to recoup its costs and make a profit). The expectations of patients can also be considered as a lobby of sorts as well.

* Courses of treatment for many illnesses, and even for routine care, appear to be based as much (or more) on what the insurance company will pay for as on what the patient needs.

* And there are many ethical issues as well. These include: decisions on how long to sustain life when the patient suffers from critical injury or terminal illness; whether a doctor has an obilgation to treat patients who cannot pay for the treatment (doctors have bills to pay and a living to earn, too); what is a reasonable level of profit for a medical professional or a drug company; and whether it is better to promote routine health maintenance care than to wait until a problem arises and grows expensive, and then treat it.

So...given all of the above (and this is only a very short list of the issues that bear on the problem), what do we do to help resolve this absolutely critical issue? As you might suspect, I have some ideas. Unfortunately, you'll have to wait for my next post to hear about them. In the meantime, read widely and think critically about the problem so that you can ask the right questions and make the right decisions...and so you can decide whether my coming suggestions are right.

This is - truly - a life or death issue.

Have a good day. We'll continue this discussion in my next post.

Bilbo