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A Doctor’s Advice: Take Three Questions and Call Me in the Morning

By Dr. Maggie Kozel
. 1 Comment(s)

Healthcare reform is a complicated subject to tackle, and unfortunately we seem to be experiencing a leadership vacuum from our elected officials just when we need them the most. Politicos and pundits hold on to their jobs by making us believe that we are a house divided: people who hate the poor vs. people who hate freedom. But, we know that these are false divisions.  Health care is a basic human need that we all understand and care deeply about, and we are not a people lacking in compassion. That is why, complicated subject or not, the American public needs to drown out the din and work towards a real understanding of the fundamental issues at play here.  Otherwise, foolishness and misinformation will carry the day, and we, the people, will be the big losers.  We need to stay focused and informed.  We need to raise the level of conversation, and demand that our elected officials do the same.

Even health care professionals and policy wonks find it hard to stay ahead of all the ideas and arguments floating around.  All the more reason to focus on the fundamentals.  Having spent twenty years in clinical practice, and the better part of a decade writing about health care, I would suggest that there are a few essential issues we all need some familiarity with if we are to have meaningful conversations:

1. Most people would agree that primary care and preventive services are at the center of sustainable, effective healthcare.  Do you understand why that is?  Do you understand why many experts feel that investment in primary care will save us money in the long run? Are you aware of the current economic disincentives currently exerted on primary care providers, and that we are facing a serious provider shortage?  What effect will Medicaid or Medicare cuts have on primary care?

Suggested reading:  The American College of Physicians  (data rich),  (more explanatory)

Bottom line:  How do the policies or positions you stand behind support primary health care?

2. Who should have health coverage? Most well-intentioned people want to be fiscally responsible, but also do not want to see others suffer.  So how do we be good stewards of our medical resources?  What plan will do the most good in the most cost effective way?  If you are convinced that certain groups can not be covered, then consider what the plan should be for them, for as we all know, everyone gets sick, insured or not. 

Suggested Reading: ProCon

Bottom line:  Are your views on health coverage authentically aligned with both your personal ethics and your fiscal sense of responsibility?

 3. Follow the money.  In what ways do traditional free market practices and fee-for-service payments influence the cost and quality of healthcare? Health care industries, even nonprofits, have been enjoying historic financial growth and expansion even through the current recession, and exert powerful influence on Capitol Hill.  Do we understand the ways that they shape our health care?  Do we trust the free hand of the market to take its natural course in health care, or are we worried about corporate misbehavior? What about the concerns that a fee for service business model promotes productivity (rapid patient turnover, tests, procedures) over quality or long-term outcome?  What advantages might a single payer model, like the military’s, offer?  What about ideas like “accountable care organizations,” “medical homes”, or  “bundled” payments to reward positive results? 

Suggested audio:  NPR  “How to Win Doctors and Influence Prescriptions"; Suggested reading: iwatchkevinmd

Bottom line: Will the payment model that you favor the most put the patient’s best interest front and center?

These are not easy questions, but they are approachable. If you haven’t done so already, why not use these to start a conversation with someone you trust?  Why not invite a panel of local doctors and nurses, and perhaps some local small business owners, to field questions at your local community center?  Or, if you like to do your own digging, go to a professional organization’s site, like the AMA, AARP or ANA to get a feel for their positions. The key is to find sources that you trust, and tune out anyone who is speaking at a volume louder than conversational.  And do keep in mind that channel surfing over cable networks is not research.  It’s more like yodeling in a canyon.  

That’s my advice, and my guess is that its probably not very different than what your own doctor would prescribe.

Share Your Comments


  1. Sue S

    One question was left out: how and why is it that the US is the only developed country that does not have universal coverage. In fact there are many countries with developing economies that have universal coverage.

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