Health Care Reform

I apologize about the two day pause; I've been busy trying to send off my residency application. I'm deferring a 9/11 post to Sunday.

"What we face is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country." - Ted Kennedy.

President Obama's 9/9/09 Remarks on Health Care can be found here:
http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-a-Joint-Session-of-Congress-on-Health-Care/

Change must happen, and the nation is now placed in a position that may make implementation feasible. What the best approach is, how the details fall in place, who irons out the nitty-gritty points, I don't know, but I found President Obama's speech to be, though general and idealistic, motivating and inspiring. The changes he's proposing - consumer protections for those with insurance, an exchange for individuals and small businesses to purchase affordable coverage, and a mandate that those who can afford insurance carry it - are just a start. They will not solve everything; rather, they will raise more issues about the massive problem of health care in this country.

I think the first is that while many more people will get insurance, we won't have enough doctors to take care of them. Already, we don't have enough primary care doctors; those with insurance currently wait months for an appointment if they can even find a doctor. The already-strained primary care network will crumble as people with new-found insurance seek to enter the system. Somehow we must mobilize more primary care resources, whether by nurse practitioners or physician assistants or incentives to physicians to avoid specializing. Beyond getting everyone health insurance, we need to get everyone a doctor, and that may prove an equally hard hurdle. Though this will be incredibly difficult, it seems all things having to do with health care reform are incredibly difficult.

The second issue is that of cost. Health care simply costs too much in this country. Things that are cheap and effective - smoking cessation, a Mediterranean diet, daily exercise - are supplanted by marginally beneficial interventions, expensive medications, fancy tests. The culture of extravagance at the expense of proven utility must change. The costs of health care must be reined in for an affordable market to emerge. And I believe costs can be contained without a decline in outcomes if there is a compensatory emphasis on those lifestyle changes that are simple, effective, and currently overlooked. This is why primary care needs to happen.

Lastly, I realize I am not going into a primary care field, and saying such things may reflect a sort of hypocrisy. But I don't think that is true. I've always felt that primary care is the core of modern medicine, that its effects are far more reaching than those of subspecialists, and I admire those with the courage to enter such a daunting field. To me, it is equally important that subspecialists recognize the fundamental need, importance, and contribution of primary care, that these front-line doctors who chose to train less are nevertheless the backbone without which health care would be ineffective, fragmented, and grossly transfigured. Indeed, that's what's happened to our nation, and it's time to fix it.