The Lifestyle Chronicles - Balance and Stability
I was there when Medicare and then Medicaid were launched. I was there when D.A. Henderson went from the CDC to WHO to direct the eradication of smallpox. I was there when the NIH budget was in its early phase of expanding rapidly every year and new specialized institutes were created. I was there when medical and surgical subspecialities were proliferating and establishing themselves. I was there when medical schools expanded class size and new medical schools associated with the VA were established. I was there when hospitals became large corporate entities, created CEOs, started marketing and advertising campaigns and later began purchasing medical practices.
I have seen explosive growth in the number and size of health insurance companies, pharmaceutical companies and medical device companies. I have witnessed the escalation of advertising directly to the consumer by these companies. I have seen all manner of financial relationships between the companies and physicians. I have seen physicians establish commercial enterprises to deliver high tech medical support services.
I have watched the growth of public demand for medical services and the proliferation of new diagnostic designations to cover a variety of symptoms. I have watched the health care system become a medical system oriented to aggressive diagnosis and therapy. I have watched as more and more resources have been dedicated to senior citizens. I have watched reforms and even aborted reforms create unintended consequences.
Someone tell President Bush that competition is not lacking in medical care. There is competition everywhere there are resources to pay for it. To the contrary, competition is a major force creating instability in the balance between health care and medical care and between those with and without resources. You get what you pay for. When you pay for sickness, you will get sickness.
Many bridges have been crossed to arrive at the current situation. It has not been a simple journey and there will be no going back. But, I fear for the future of my medical colleagues. The health care system is out of balance creating instability that directly impacts their professional future.
Many feel the situation is beyond the control of physicians. I would hasten to add that physicians can change the system more quickly and effectively than any government reform effort. Physicians can get other health professionals and health entities to join them. Physicians can begin to devote more attention to primary prevention and the lifestyles of their patients plus the community. Physicians can regularly review the medications a patient is taking with the intention to decrease or eliminate those that are no longer necessary.
Primary care practioners are poorly compensated for the amount of work they do. I have never been able to find the justification for the difference in compensation between primary care and speciality care. Some have advocated reforms to correct this imbalance. Don't hold your breath and don't expect the resurrection of the "gate keeper" role. Let us create something of value that will change the system.
Primary care providers can reinvent themselves to address some of the major problems and take advantage of future trends in health care. Converting from "sick call" to health risk management and expanding the scope of attention to include institutions and organizations in the community will add value to the health care system. And, it will establish primary care in a leadership role.
Primary care providers need to sharpen their education and public speaking skills. Teaching patients and the public how to achieve and maintain optimum health is far, far more valuable than prescribing medications. Universities and programs that educate health professionals need to focus on this matter. More research is needed on health behavior, and where and how intervention is most effective. This brave new world of communications provides opportunity to be more effective at a lower cost and primary care providers should become experts and innovators.
Obviously, this will take time to have an impact and it will require innovative financing mechanisms. The money is there and it can be redirected to something of value. If the President and Congress have any sense at all, they could start the process by reallocating Medicare Part D funds to prevention. Don't be afraid of the old folks, they don't like Part D and they will probably vote for you anyway. I am not so sure about the AARP. My recent post on Part D that Barbados Butterfly so kindly included in Grand Rounds wasn't very popular but hope springs eternal.
Healthy People 2010 lays out an ambitious agenda that begs to be implemented. Governor Huckabee has started the ball rolling in Arkansas and Governor Sanford has followed suit in South Carolina. The National Governors Association is currently chaired by Governor Huckabee and he has set the topic of Healthy America for the NGA Forum in Washington DC later this month. CardioVision 2020 is a health promotion project for Olmsted County, MN and there is an informal health challenge with Healthy Greenville in Greenville County, SC. There is a Healthy Dekalb County and the Centers for Disease Control and Prevention is a resource.
There will always be sickness, disease and trauma. That is the orientation of the current medical care system and primary care knows too well its role in sick care. I may be an older fart but I am a very lively older fart who is not interested in being sick. I want you to focus on keeping me well. Come on, let's get going before the hospitals decide to build another addition dedicated to perpetuating disease.
It is said that all politics is local. Perhaps the same is true of health. Personal responsibility and community commitment to optimum health should be led by the health professionals that people know and trust. Count me in.
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