I think the American health-care system is basically
broken. It shows the effect of heavy lobbying by the pharmaceutical
industry, insurance companies, HMOs, hospitals, and the A.M.A., tilted
toward subsidizing expensive procedures and products that mainly improve
the bottom line of those institutions.
We need to focus on reducing costs rather than
providing universal insurance coverage. Otherwise, it’s estimated
that in the late 21st century health care will consume more than half
of GNP. Yes, the bean counters have a role to play in this debate
- me, being a former cost accountant.
I think that prevention is a cost-effective approach
to medicine. If people can recognize dangerous illnesses early in
the game, then the illnesses can be treated more cheaply and with
a better success rate. But the uninsured fear even seeing a doctor
since the fees are high. The likely result will be a prescription
for expensive pills.
Therefore, let the government provide free service
- not unlimited expensive service, of course, but basic service such
as an annual physical and record-keeping assistance. Therefore, I
am proposing a three-pronged service - all free - which should cost
the government less than $50 billion a year to benefit all 300 million
U.S. residents.
First would be a bare-bones physical, once a year,
which would be a generic examination - hence, cheap - with some tailoring
to a patient’s known health risks. This would provide basic information
and recommendations but, beyond that, nothing. It would be up to the
patient to decide whether to contact a doctor.
Second would be genetic testing. This technology
is in its infancy. A basic procedure would be developed to assess
various health risks so this information could be factored into treatment
decisions.
Third would be a website. The results of the annual
physicals could be posted there for easy retrieval. Additionally,
the website might give simple medical information about types of illnesses
or disease related to a patient’s data and questioning.
With respect to genetic testing, there are private
companies that will assess a person’s DNA for health risks. Three
of these are Decode Genetics, 23andme, and Navigenics. The cost is
approximately $1,000. However, if millions of people were genetically
tested, costs would come down. This type of information would be invaluable
in treatment and prescription decisions.
Come to think of it, a genetic profile of the patient
is essential for prescribing medications. The drug companies are continually
developing drugs and testing them on groups of people. Those that
are shown effective to groups are approved. But, writes Dr. Bernadine
Healy in U.S. News & World Report:
“Template care is increasingly at odds with
the emergence of personalized medicine, a new discipline driven
by the exploding knowledge of the human genome that guides treatment
tailored to the individual patient. And this is what today’s
medical students will be practicing tomorrow.”
“Thanks to ever better, faster, and cheaper
sequencing technology, researchers have shown the many ways our
25,000 or so genes can vary. One little glitch - a misspelling,
a hunk of DNA lost or added, or a gene altered by interplay with
other genes and molecules - can affect disease susceptibility or
treatment. Already, researchers have tied genetic differences to
many diseases, including diabetes, heart failure, autism, restless
leg syndrome, multiple sclerosis, and rheumatoid arthritis. Imagine
this in medical practice. Knowing your patient’s risk early
on would bring more targeted prevention.”
(U.S. News & World Report, April 7 &
14, 2008, p. 59)
With respect to medical information on the web,
Google is experimenting with a pilot program to store personal medical
records for several thousand patients at the Cleveland Clinic. An
advantage would be that patients could access this record no matter
where they received treatment. Microsoft is offering a similar service.
A new venture from a firm based in Plymouth, Minnesota,
which is called carol.com, aims to facilitate a medical market place
where customers could post information about their particular ailments
and solicit bids from prospective health-care providers. Patients
could also post reviews of the treatment that they have received.
In other words, carol.com would help people compare prices and services
from available service providers.
In short, new technologies in the areas of computers
and medicine could both lower costs and improve the quality of medical
treatment. With little additional expense, the federal government
could help to bring this system into being.