Some preliminary thoughts

All Must Suffer
by Morris Alex, M.D.

Over the past several years, there has been increasing pressure for changes in the healthcare system. The press and the politicians use one-sided information to promote their own purposes. An ideal concept is presented to the public without advising them that developing an ideal system will require everyone— consumers, providers, insurance companies, hospitals, medical schools, politicians and researchers — to suffer. Let us examine how each group will need to give up some cherished positions for the betterment of all.

The Situation

What does the average American want from the healthcare system? They expect immediate accessibility, affordability, technology and quality care, but no increase in taxes. However, when a poll was taken by the Employee Benefit Research and the Gallup organizations (1), some interesting and conflicting attitudes became apparent.

* Only 14% of respondents agreed that reducing the amount of healthcare available to the elderly would be acceptable.
* 34% agreed that public funding for services to low-income individuals should be limited.
* 39% agreed that the scope of services covered by health insurance plans should be limited.
* 43% were not willing to limit the introduction of expensive high technology equipment that saves lives, but increases costs.
When specifically asked to name what they would limit if needed, the respondents noted the following healthcare services.
* 72% agreed that expensive treatment not likely to be successful should be limited.
* 64% agreed that expensive treatment that extends peoples lives but does not improve the quality of life should be limited.

The majority of the respondents did not believe that expensive treatments for patients over 75 years of age should be given solely because they would enable the patient to live in comfort, but not live longer. In addition, 77% of respondents felt the cure for rising healthcare costs is to cut the waste, the high profits and the fraud in medicine.

Forty-six percent of Medicare dollars have historically been expended in the last 60-90 days of life and 75% of those charges have been generated by hospitals (1)). Therefore, it appears that the public, while wanting the ideal, is willing to compromise. Whether they are willing to pay more taxes or participate in managed care that steers choice of physician toward a network is still open to question. The fact that PPOs are increasing more rapidly than other managed care concepts would seem to indicate that the American public still highly values being able to choose their own physicians.

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