Editor's Opinion: Healing the Wounds of American Healthcare: Investing in Our Future
Whatever change we pursue, we will need to work together to reform healthcare. We beseech clinicians to be part of the healthcare change endeavor. — Dr. Henry D’Silva1 (Ostomy Wound Management 2008)
During the past 12 months, much more has been said than done about health insurance and healthcare reform. Hopefully, you have been part of the discussion. If not, it is not too late to give voice to your concerns. In August, members of Congress are back in their districts and away from the lobbyists in Washington — your opportunity to make yourself heard.
The stakes are high for everyone but clearly some have more money to spend defending their positions than others. Healthcare lobbyist spending has been brisk: During the first quarter of 2009, the pharmaceutical and health products industry spent $66 million and the insurance industry $41 million and second quarter spending for the top four healthcare lobbyist groups was another $21 million.2,3 Almost as if to confirm that our health insurance and healthcare system is a runaway train, United HealthCare reported their second quarter 2009 profits of $859 million were more than double their second quarter 2008 profits.4
Meanwhile, every talking head and columnist has become a healthcare expert. Many have joined the politicians who are wringing their hands, worrying about how to pay for the cost of improving access to quality care. The noisemakers are drowning out the voices of the real experts and scientific data are replaced with results of “leading question” surveys and case studies. The latter are reminiscent of the stories told in the 1990s that helped pave the way for our current market-based/consumer-driven healthcare system. Knowing the “success” of that campaign, it is truly amazing to hear voices arguing for more of the same!
Health insurance premiums have increased at four times the rate of inflation. Bureaucrats (instead of providers) are making healthcare decisions via utilization review, pre-certification, concurrent review, and discharge planning. Co-payments have increased provider paperwork (and cost) and may keep patients most in need of care out of the office. Generally, co-payments do not appear to affect office visits and medication usage, but they do affect care-seeking among patients typically seen by OWM readers (ie, the elderly and persons with chronic health conditions) in part because these persons already spend a significant proportion of their income on healthcare.5 Case in point: Medicare beneficiaries have seen their out-of-pocket healthcare spending increase by 53% between 1997 and 2005.6
Instead of media-hyped mass hand wringing regarding how to pay for changing the status quo, people — even folks who have profited from the environment to be changed — need to assert that this market-based model should focus on sustainability. If we do not invest in a sustainable healthcare and health insurance system, the number of persons able to access it will continue to decline and unsustainable cost increases will remain. Fewer and fewer businesses and individuals will be able to purchase health insurance and/or receive the care they need.
Committing resources to improve outcomes and reduce costs is a concept clinicians are uniquely qualified to discuss. Evidence-based practices involve making investments to reduce long-term costs; such efforts include providing offloading footwear in persons with foot ulcers and pressure redistribution surfaces for persons with limited mobility. Just as the argument for diagnostic equipment was won, knowing it would improve care and help sustain our practice, companies will spend money to conduct clinical studies because if their products are efficacious and cost-effective, they will see a return on their investment and patients will have better outcomes.
Groups interested in protecting their (often substantial) stake in the business of healthcare are expected to make a lot of noise in the coming months. As patient advocates and real healthcare experts, we must do the same. We can educate our patients and legislators about the principles of cost-effectiveness and tell them, “Yes, the proposed treatment may cost a little more but it will help heal this seriously wounded system in a timely fashion, saving us money in the end.” That’s the kind of investment in healing they understand.
This article was not subject to the Ostomy Wound Management peer-review process.