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Patients, Not Government, Can Fix Health Care
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Senator John Barrasso, a physician, on what the current health-care bill is missing: a focus on patients and preventative care, not government.
More than half of the money we spend on health care is spent on just five percent of the people.
Basically, these are people who eat too much, exercise too little, and smoke. They develop costly and often preventable conditions: high blood pressure, heart disease, diabetes and many types of cancers.
We need incentives to encourage people to live healthier lives. It's the first step we should take to control the cost of care.
State employees often have access to state-paid screening exams. This common sense approach recognizes the value of early detection and prevention. Washington, D.C. does not.
As a physician practicing in Wyoming for 25 years, I've been fascinated to see how little Medicare will pay for a doctor or nurse to spend time teaching a diabetic how to control blood sugar. Medicare pays much more to treat the complications when a diabetic's condition becomes uncontrolled.
As the medical director of the Wyoming Health Fairs, I annually supervised the blood testing of over 50,000 Wyoming family members for over two decades. We test for cholesterol, diabetes, anemia, thyroid problems, prostate cancer and much more. With the help of these programs, people have taken charge of their own health.
State employees often have access to state-paid screening exams. This common sense approach recognizes the value of early detection and prevention. Washington, D.C. does not.
Amazingly, Medicare still refuses to pay for these low-cost exams. Medicare routinely pays much higher prices for individual blood tests if a patient has symptoms. Medicare does not cover screening tests to help our seniors identify problems early. It’s no surprise Medicare is going bankrupt.
Businesses that want to motivate their employees to adopt healthy habits face a maze of government obstacles and regulations. They have to contend with a bewildering Washington bureaucracy. The Health Insurance Portability and Accountability Act, the Americans with Disabilities Act, the Employee Retirement Income Security Act and numerous other rules that make it difficult for them to create effective incentives.
The proposed Senate health care reform bill does not improve the situation. While they pay lip service to prevention, the money is spent on walkways, street lights and jungle gyms. These projects may be worthwhile, but they do not get people off the couch and into a healthy lifestyle.
We can do better. Real health care reform must be focused on the patient. The way to reduce costs and improve health is to create incentives for people to take responsibility for their own health.
There are different approaches to helping others stay healthy.
One approach says people generally can be trusted to do the right thing, and society prospers when government has less to say about how people run their lives. Others start by assuming that Washington knows best and that government should take more authority over all of us.
I prefer individualized incentives that encourage healthy behavior. Regrettably, our current health care system is not built to highlight wellness and prevention—nor do the reforms currently under discussion in Congress.
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jds8181
This is, hands down, the most amazing, accurate and articulate article I've read since the healthcare debate began. As someone who tends to vehemently disagree with anything Republicans have to say when it comes to the debate, I would like to congratulate Sen. Barrasso for stating what needed to be said. When I voted for Obama last November I did so with the hope that he would immediately begin encouraging Americans to make better lifestyle choices, and thus far I've been sorely disappointed. I'm glad someone had the courage to step up to the plate.
Now America needs someone to take the next logical step and point out that we will never be able to deliver on prevention until we tackle the Farm Bill. We as a nation subsidize obesity by essentially forcing people to eat garbage. It's time we stop giving subsidies to farmers to produce corn and start subsidizing more healthy fruits and vegetables, like peppers, blueberries, etc. It is far too expensive for people to eat healthy, which is almost criminal.
estcruzer
If we prevent health problems our healthcare INDUSTRY will collapse from over capacity, if we change our eating habits our corn and beef INDUSTRIES will collapse from over capacity - how can we advocate that?
By the way, this is a common theme for several other INDUSTRIES that sell and promote things that endanger our health, both physical and mental (OIL, ARMS, TRANSPORTATION, ENTERTAINMENT, ...). You would think that our government would recognise this and take steps to keep us from collapsing these industries. wait, the Republicans are doing just that. Of course, the fact that the rest of us are being killed by these INDUSTRIES doesn't count for anything with these Republicans since their electorate seems to be BIG BUSINESS, which they represent quite well. Just listen to their rant...
crypto
Good article: Now closer to the point for me. Kids are taught by the time they're old enough to eat solid foods that McDonalds is the place, Micky "Ds"
oh yeah. WE have fun meals, playgrounds, surprise packs and clowns to draw 'em in. And the same fathers and mothers who tell their children how bad smoking is will take them in the fast food place five days a week and fill 'em fulla fatburgers. Just today while shopping I saw a woman with five children in tow. The oldest about 10 years old down to about 4 and all were so overweight they waddeled. The reason I bring those kids up is they were all carrying sacks of food from Burger king. This is a fast everything society we llive in. So unless somebody can figure out a way to dictate what the public eats we won't ever have the perfect picture of health. Don't blame the farmers. Blame society itself.
nickels1
but it takes a generation to improve. the mean time we die. like smoking. years and years and finally just over 25 %.
Generations! until then we need the bill. then when the next genreation comes the cost will be cheap as diirt. but till then we die. her wants money to be made money to be made.
eurydice9276
This is so true. Most people don't even think about diet and exercise as a way to control high blood pressure or cholesterol, nor do most doctors.
Some months back, my mother was tested with high cholesterol and the doctor immediately prescribed Crestor (at $175 for 90 days). When my mother asked if there wasn't some sort of diet she could go on instead, the doctor was shocked. He said, "Really? You'd be willing to do that?" They worked out a plan, my mother's losing weight and her cholesterol levels are steadily improving.
Money saved all around - plus, my mother gets to buy a new wardrobe, which will really be a boost for the economy. :-)
Mariafrania
I guess if your mother hadn't realized before that diet and exercise are the key to having a good cholesterol level, I can imagine a doctor dismissing her as someone who doesn't seem that much interested in practicing healthy habits.
It's almost like someone who's fat blaming his doctor for not telling him explicitly that he shouldn't live off of fast food.
Americans, always wanting to blame someone else for their problems, and then suing whenever possible. I guess that 200 year old culture still has a lot of growing up to do before they catch up to the thousands of years of wisdom and maturity that Europe has cultivated.
Sajwert
eurydice, your mother and I have faced the same situation. My cholesterol level is not high, but needs to be brought into better numbers.
I absolutely refuse to take medication, and have decided that I have no other choice now but to eat better and learn to be a Mall walker at 8am every day. When I consider how much the medication costs, and how it adds one more pill to the list of 3 I already have to take, I just didn't feel that losing weight and walking would be worse. Plus, although my BP is under control, it is because of meds. I think that the weight reduction and walking should kill two problems with one stone.
Wish me luck in doing as well as your mother sounds like she is doing.
dabouv
I too am a Dr. and I believe we need fundamental reform. I do not believe that the health insurance industry or the medical industry is capable of doing this, nor in many cases has the incentive to do so.
First we have to decide if BASIC healthcare is a right. I believe it is. Everyone should have access to affordable and available healthcare . I don't care how we get to that. I don't see how a business who is out to make money will ever decide that covering a high risk patient is a good idea. Why would they spend front end money on prevention knowing that the person probalby won't be with their company in the future? Why should we tie insurance to work?
Hospitals are horribly run. Every competing hospital in my city has the same services. If Hosptial X gets a new technology, hospital Y gets it too even if the need isn't there. it is competition but it doesn't drive prices down like in other areas. Do we really need birthing suites that compete with the nicest hotels? I think sure, if you are willing to pay for the additional fee but that isn't basic healthcare. Does anyone think that when someone owns something they don't try to maximize its use? There are a lot of studies that show what happens when Drs. own a modality, use skyrockets. I see it all the time.
Patient compliance is terrible. Sure, there are people who will make changes but anyone who thinks that is the majority isn't dealing with the reality that I have seen. I see sleep apnea patients all the time and I send them to a formal dietary consult and the long term compliance is terrible. I doubt 5% lose weight long term.
We need to relook at medicine. I would point to my own specialty, ENT. Why not have a basic ENT training which is 2 or 3 years instead of 4 or 5 after the intern year? These guys could do the basic cases and then have subspecialists for the more difficulty cases. A complicated ear surgery takes me 3 hours while I know subspecialists who can do it in 1/2 the time. It might be a drive but so what, it is better care. Primary care will have to increase their training if they are going to be how we drive down costs. Frankly, in most areas in my specialty they are consistently wrong. Headaches are not likely sinusitis, I have never seen a cholesteatoma diagnosed by the primary doctor, and hoarseness in a smoker needs a scope, not 6 months of antibiotics.
We need to eat less, exercise more, quit smoking, moderate alcohol, and change the types of foods we eat. People need to live within their means and learn to minimize their stress ie not make life more difficult. That would definately decrease the number of people on medications for sleep, depression, anxiety, etc...
There is also a huge difference among populations. What works in a relatively homogenous high employment state like Wyoming may not work so well in rural Kentucky, inner city Baltimore, etc...
We pay too much for healthcare but the bigger issue is that we get too little for what we pay. The US has by far the highest medical spending of any major country and we get at best middling results. Why not take the French system at 1/2 price then let people pay for "Cadillac" features if they want them? Imagine if every man, woman, and child had an extra 300.00 mo. of disposable income?
AlanD2
Nice post, dabouv. I've been pushing the French health care system so long here that everybody is tired of hearing it, so I'm glad somebody else agrees.
Mariafrania
I agree too. I've lived in Europe since 1993- in 4 different countries, and I can tell you, the health care here is a lot better. And the people wouldn't even dream of having the type of system that America has. I think Republicans haven't traveled enough, have no imagination, and are just plain ignorant to reality. America should send as many as possible of its college students abroad on foreign exchange programs. Maybe then they won't be so narrow minded.
Dreamer4Ever
This is amazing.
Ladies and gentlemen, the Republican health-care plan REALLY IS "Don't get sick!"
"Don't get hurt! Eat right and be healthy and everything will be fine!"
What GENIUS! I can't believe the countless patients who've had coverage for necessary procedures denied by their insurance providers didn't THINK of that before they sold their homes to try and save their own lives!
Ya know what, let's go one step further and start treating people the way we treat race-horses: they fall on the track, they get some sorrowful words and a bullet to the head. Requires no government regulation, in fact, requires no actual medical professionals at all! The insurance agent can do it themselves! Our premiums will plummet! Lives will be saved, and by lives I mean money!
Mr. Barrasso, MAKE THIS LAW! LIFE IS ONLY FOR THE HEALTHY!
eurydice9276
Actually, this is also a part of the Democratic health-care plan - what do you think "preventive medicine" means? It means helping people to not get sick in the first place. The most prescribed drugs in the United States are for high cholesterol and high blood pressure - in most cases, these conditions can be controlled through diet and exercise. But people believe in two conflicting "god-given" rights - the right to do whatever they want to their bodies, and, at the same time, the right to have somebody else pay for the results. Recent studies have shown that the health benefits cholesterol and hypertension medication have brought to the public have been entirely negated by increased obesity.
Please don't let partisanship blind you to perfectly sensible suggestions. The senator isn't saying that insurance companies shouldn't cover necessary procedures or that people don't deserve health care coverage - just that there should be greater emphasis on encouraging people to live healthier and less drug-dependent lives. President Obama has said the same thing himself, many times.
cheapseats
Of course preventive medicine is the proper direction for the profession to go., but that is an issue for practitioners. The good doctor is complaining about his financial reward well he explains what he and I both expect, good medical practices. If he has a beef with health care perhaps his professional organization should get to work lobbying for a change of focus.
This internal concern of the professionals is hardly the reason for denying coverage for millions of people. I think denying vacation homes for doctors is preferable.
Additionally, would the good doctor actually denying citizens to live and eat as they like in favor of a government prescribed diet. I know that is not his intention but the opening of this opinion piece seems to suggest that treatment should be offered only to those that follow medical advice. How totalitarian of him.
estcruzer
This is actually a concern for our government, why do you think they created the program to educate us about the food pyramid (other than to promote the beef and dairy industry). Supposedly it was to brainwash us into eating what was then considered a healthy diet.
A strong nation will depend on a strong, alert, educated and intelligent populace, nothing else is a powerful. A good illness prevention system, a good education system, a good information dispersal (read free internet) system will make this country so strong it will not need a military presence in half the rest of the world - and it would cost a lot less.
jojo12
Medicare has financial problems thanks to Medicare Advantage programs, doctor's who over-bill & schemers who establish medical supply companies with the intent to bilk Medicare. Medicare needs to adjust how it pays it's bills. Safeguards need to be programmed into it's payment system for bills that are higher than a set dollar amount to be flagged for review.
Why hasn't the Senator worked in a bi-partisan manner to make health care affordable for all Americans? Why hasn't the Senator introduced a plan to save Medicare from the crooks who bleed the system?. Why hasn't the Senator introduced legislation to add preventive care to Medicare?
AlanD2
You've got to be kidding, jojo12. Any Republican who votes in a bipartisan manner will be labeled a RINO and kicked out of the party (or at least challenged in their next primary by a conservative extremist - a la New York district 23).
Mariafrania
Yes, many Americans are sacks of lard that waddle between their fridge and the closest McDonalds. If anyone has thought of a way to separate these beached whales from their Super Size meals, step up and announce it. Until then, we cannot allow health care to be ruined for the rest of society just because a portion of the population can't handle their appetites. These grotesque obese beings are expensive to keep alive, but let's just consider this a test of our humanity. Selfishness and greed aside, let's help everyone in any way we can- preventative or other. Look at Western Europe. People there are healthier, happier, skinnier, and richer than in the USA, and they have universal health care to thank for it. One would think that when something works, that would be the plan of choice.
Farmer-Dave
I'm just curious; why didn't the author mention that Barrasso is a REPUBLICAN senator?
jojo12
The author of the piece IS the senator. Maybe he's ashamed to admit he's a Republican.
mindlessmissy
What IF you have to be at the hospital for something that has NOTHING to do with how fit you are ... ?
We can't just say we are going to stay fit and wish OTHER disasters DO NOT occur .... !
AlanD2
Personal responsibility is a big conservative talking point, mindlessmissy.
So of course they are going to try to pin the blame for being sick on the sick person.
Desertpenguin
Yet another health-care debate without Plantagenet.
It's good to breathe digital fresh air once in a while.
calpoet
This essay is comparing oranges and apples. Of course we need to take preventative measures to take care of our health as best we can, but all the preventative measures in the world won't end sickness and the basic pains of our mortality. This country's health care system is in terrible condition and badly needs major reform. I think we should get insurance companies out of the health care business altogether, but since that's obviously not going to happen the next best thing is to take strong measure to keep them honest and limit their control over our lives. The public option is clearly the best way to do this and the usual Republican rant about government taking over our lives just doesn't cut it in this case.
shag11
I am happy to see the emergence of the Urgent Care centers. When we complete this health care reform, they will help to fill the void of not having enough doctors. Also, many drug stores are now providing registered nurse to handle basic care issues.
dabouv
i think this is a terrible solution. The problem with many primary care doctors, especially since FP programs more and more train their people within their specialty and give less exposure to the specialties is things get missed. There is a saying, when you hear hoof beats, look for horses. That is fine but sometimes it is zebras and you have to know what you don't know. There are excellent primary care doctors but I will tell you the majority that refer to me use antibiotics like candy and fail to change practice which has been shown to be wrong. Best example is "sinus headache". Without getting into this, it is rarely sinusitis. Nurse practitioners are much worse. First, as a rule, they are not as smart as the physicians. Not always, but generally. Nursing school is not very rigorous, it is basically an associate degree with a practicum ( I started in nursing school and I do know what they take). The training after the RN is much less than a residency. There is no easy solution but NP's working out of Walgreens doesn't seem like a good solution to me.
matthewbenzor
This is one doctor I would'nt want treating me, he would go with what the insurance wanted to do you,and "NOT" what needs to be done.He is a "insurance doctor "the type that writes the referal to the insurance company and barters for your care, This Senator is a "HACK" doctor who would chose what the insurance wanted to do to you,rather than what needs to be done to you, its called rationing your life for profit, SHAME ON YOU SENATOR and you call yourself a christian far from it my friend ,Jesus would "NOT" be happy with your care of his children and is "NOT" happy , God have mercy on you,for "LYING" to your patients about what kinda od care your giving them..............! PHONY,FAKE and a FRAUD
samgyupsal
Good article, maybe this senator can try to join the debate and put his ideas in. Unfortunatly he will probably just try to stonewall everything cus he's on the wrong side of the political fence.
AlanD2
He's a Republican, samgyupsal. Of course he's going to vote "no" on health care reform, no matter what is in (or out) of the bill.
jojo12
A year ago, while visiting a relative who was hospitalized, I heard a woman from another room crying out for help. The woman was elderly, quite frail & laying half on/off her bed. I didn't dare to move her. I rang the buzzer to the nearby nurse's station to seek help for the woman. There was no response. I went to the station & found both doctor's & nurses there. My presence was ignored as they all had their heads down, typing away at their computers. I yelled out that a patient needed immediate help. Grudgingly, one nurse, the nurse assigned to my relative, raised her head to ask me what the problem was. I told her about the elderly patient. The nurse ignored me & returned to her computer. I then shouted, what the hell do I have to do, call 911. The nurse then went to the elderly patient's room. The patient was now on the floor & the nurse called out to the nurse's station for assistance. Doctor's & nurses responded, I could not help but overhear their comment that the elderly woman may have broke her arm.
Later, I questioned the nurse as to why their computers were more important than a patient in danger of falling out of her bed. Her response was, "ask the Insurance Companies, they dictate how we do our jobs". She then went on to tell me that Insurance Companies demand daily computer records of every patient interaction that takes place. The doctors & nurses were complying with Insurance Company rules prior to shift changes.
The hospital has a good state rating. It's clean & well staffed. Unfortunately, it like others in this country, has Insurance Companies dictating to them, with the end result patients come second.
Thank you.
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