TURNING BACK TO FIND THE FUTURE ?

A majority of the American people are outraged by the "immoral conduct" in the corporate world, the "excessive" profits in the Pharmaceutical Industry and the "rising costs" and salaries reported by "privately operated" Managed Health Care Plans--as they watch their retirement plans "vanish"; find it "impossible" to afford life-preserving medicines and are expected to settle for a "diminishing quality "and quantity of the health care "provided" when they are in need.

Truth is, they supported the growth of a "private enterprise" managed health care system. The promise of "better health care at a lower cost" failed to materialize. In short, the new system put into place failed to deliver, They know they must look for an alternative.

With polls showing a majority [70%?] of Americans favor a Single Payer Health Care System [such as exists in Canada?] the federal government could take control of health care delivery with the formation of a new bureaucracy or with the current system in place but financed and controlled by government regulation..

In the event that a National Health Service is their choice, State Governments could function in an essential but subsidiary role. Quality Control issues would then be returned to Physicians now that it is apparent that cost control can only be achieved by a reduction in the utilization of services, the quality of the Providers who deliver that service and of the materials made available to them. In other words through "Rationing of goods and services".

A national health service might choose to function by expanding the existing Medicare structure to cover all age groups while using the State Agencies in place or the facilities of the private health Insurance Industry as it currently exists. Delivery of care, at the community level, would be under the direction of regional and local committees composed of consumers and provider who would be guided by federal regulation and a limited budget.

Comments that suggest "the Government doesn’t want it" should be dismissed. Federal Bureau records expressing the belief that Government control is needed to solve the nation’s health care delivery problems have been heard since 1972. [ref: Forward Plan Of Health, FY 1978-82, US Department of HEW, page 1, publ. August 1976]<P>

Providers [Doctors, Hospital Workers  and other health care professionals] who would have resisted a takeover, then, are more likely to welcome it, now, as they become increasingly concerned with their financial survival rather than the provision of quality patient care.

This new health care system would try to avoid the errors committed by existing national systems, but if history is to be our guide, it's not likely that we would fare any better. The reality is that blood is red no matter where it’s spilled and pain is the same no matter when you get it or how you say it. All sick people are the same and so too is the help they require.

After visiting several nations to study their health care delivery systems, those in existence are very much alike as are the problems they encounter/create. The outstanding similarity in all is promptly delivered, non-emergency care of good quality is available, only, outside of the system, in private offices or hospitals, for cash or supplemental private health insurance. Formerly,this service was readily avaiable in all but one nation I visited, Canada. However, in 2006. a Canadian Provincial Supreme Court Ruling mandates that Canadian Citizens be allowed to purchase private health insurance, in addition to taxes, if they wish.<>

Wherever private health insurance is available the result is the creation of the "two tier system of health care that was expected to become unnecessary. One for the poor who cannot afford anything else and another for those who will pay additional money [beyond taxes] for better care. Should we expect it to be any different here in America?

"Corporate Care", now dominating our health care scene is proving to be unacceptable because of its primary concern with profit on the provider side competing with the demand for prompt and total care on the consumer side. In America, delivering health care with profit in mind or withholding needed services for budgetary reasons is unpalatable when dealing with sickness and dying ---even more so today when so many American feel that immediate access to high quality health care is their right.

Health care costs would continue to increase during a transition to any new system as patient enrollment increases and more sophisticated methods of diagnosis and treatments are discovered. In addition, under a National Health Service more administrative levels become necessary, some nations have nine, and each requires a budget that can be expected to increase every year. As a result, less money becomes available for patient care, waiting lines begin to form. This, the most visible form of rationing, is accompanied by other less visible forms of rationing currently in use by the, only twenty years old, "Corporate Care" model. Examples are longer waiting periods for necessary care by requiring pre-authorization or possible denial of necessary medicines and surgery, shorter hospital stays and, in the not too distant future, the likely denial of services  because of unhealthy life styles, obesity, smoking and substance abuse].

Traditionally, a "fee for service" system flourishes in a democratic society that is economically sound. Today, as both individual and corporate economic security decline demand for less costly health care intensifies without any less intensity in the belief that access to total health care is a right that should be guaranteed to all regardless of ability to pay. It is precisely this concept, "equal care for all regardless of ability to pay" that is causing many hospitals to close their doors, for lack of funds. It's effecting physicians as well. Many have been forced to look for salaried positions rather than continue in, or open an office for, the private practice of medicine.

A return to the era of the private practice of medicine, as I knew it, is unlikely in the near future, if at all, in light of the massive changes in Hospital and Medical Clinic design; reimbursement schedules that discourage solo private practice and the greater understanding of the cause and treatments of many diseases. Today, diagnosric procedures are better, yet more expensive to provide and  treatment of disease more promising, yet more expensive to obtain. With this knowledge in mind, no matter what health care delivery system we choose slogans that suggest "Something for nothing" or "It will be better and cheaper" should be ignored.

I believe that American citizens cannot swallow the idea of RATIONING or PROFIT when it comes to health care. To support my position I read in this morning’s paper that a major hospital chain has agreed to treat two children with a rare immune disease. The only known treatment is experimental, will cost 600,000 dollars and will not cure the disease. The treatment carries a 30+ % mortality rate. In the same issue, an editorial writer argues that Medicaid [welfare] patients should have access to name brand medicines despite the increased cost. News obtained on the Internet reported a 13 percent increase in premiums, for employer-provided health care insurance, which will force some employers to discontinue providing that insurance unless they can demand that their employees pay more, such as a higher co-pay, when they use the insurance .

Traditionally, extra money made by hospitals, was used to guarantee their ability to make available to all of their occupants, "regardless of ability to pay", the very best care, when needed. Doctors were allowed to charge a generous fee for their effort to deliver "up to date and high quality care" to all of their patients, regardless of race, creed or religion, at any time of day or night when it was needed. In recent years, however, the Doctors and the Hospitals are portrayed as outrageously profit oriented.

The public demanded that changes be made and they are taking place. Fortunately or unfortunately, depending on your point of view, changes in such significant social services, as a nation's health care delivery system, are slow in their development. Our traditional system had been functioning, as such, for near one century. It cannot be changed overnight. Researchers who study such social phenomena tell us that three decades of trial and error are needed to place a new system. They describe an 80+ year cycles to find, use and then discard a total system. Interestingly, the USA and Great Britain are at a similar place but on different sides of a cycle [circle]. They, from my observation, are moving away from a National Health Service as we appear to be moving toward one.]

My Conclusions:

1. As the years pass, the public's demand for quality health care for all, regardless of one's ability to pay, diminishes as the rising cost coupled with an oppressive tax structure weakens their concern for the needs of the poor.

2. National health care systems employ a large number of citizens, estimated to be more than 5 million people in Great Britain. Though this may appear attractive, at first glance, it can later become the obstacle that makes the system impossible to change or remove when proven unsatisfactory [where else would you employ all those people?].

3. As the tax burden enlarges should the efficiency of the system decline, the private fee for service, practice of medicine returns [that's paying twice for the same thing]. For example, despite a U.S. Postal Service, UPS, Federal Express and other delivery services have become profitable..

4. Great societies reinvent the wheel when enough time passes for us to forget what a wheel looked like. For example: new "Corporate" health Planners are hiring Doctors and Hospitals to cover subscribers despite the fact that Blue Cross/Blue Shield and others were performing that function. Why didn't we fix what was in place, then, by demanding a reduction in premiums with a guarantee of coverage for everyone.

5. We are/were not spending more for health care than other major nations. They spend it differently and some had fewer Seniors, for many years, as a result of lives lost during WWII. Germany and Japan and Great Britain report that health care costs are rising rapidly.

6. I see an irony in the fact that many Americans act as if the Medical Profession invented the concept of greater personal satisfaction and financial reward for hard work and intellectual achievement. These rules of achievement have always been, and will never cease to be amongst the basic foundation stones of a free society operating in a free enterprise system. If such a nation chooses to abandon such principles it will be only a short period of time before they reappear.

Finally, the American public did enjoy the benefits of the greatest health care system that man has ever devised. Too many, however, have lost sight of that fact and are demanding that changes be made, and quickly. This is occurring despite the realization, by many health care professionals, that inordinate demands will soon be placed upon any new system we choose. Many of our younger citizens seem bent on their own destruction through poor nutritional habits, cigarettes, abuse of drugs and alcohol, and failure to protect themselves from deadly sexually transmitted diseases.

Ignoring these developments, our nation continues to be more concerned with reducing the cost of health care and getting rid of incompetent, greedy and dishonest Doctors. Pity, if it doesn't turn out that way. For, if we don't do it right, we will pay more, get less, and bad Doctors like bad people, won't go away either.

I believe "He who fails to learn from history is doomed to repeat it".

So I ask

Why do so many of us who hear those words act as if "they must be meant for someone else.?"

Vincent W. Cangello, M.D.,FACS,FACOG,FRSM

Director , Health Care Reform Educational Institute

Lincoln, California [www.healthcarereform.com]

Former Professor of Health and Medical Sciences

University of California, Berkeley