This e-mail arrived this morning from a friend:
“Well, I have been back to the doctor and the surgeon. They can’t put in a stent because my arteries are too small. They want to do compression wraps for seven weeks which should cause new arteries to grow. Well, the co-pay for each treatment is $40 which adds up to $200 a week. The simple answer is that we don’t have the money. I figured out that next year, when I can start collecting social security, a whole $300 a month, I can save up $1400 and have it done then. Of course, it will probably cost more then. I just wanted to keep you updated and thank you for your prayers.”
In my position as President of both a medical center and research institute, it is obvious to me that filmmaker Michael Moore’s new movie, Sicko, has, in many ways, nailed it. It deals with this country’s health issues. We live in an incredibly prosperous country, but it is a one that has never had a health policy. Many of us in this profession believe that it is unconscionable that we have an estimated 45 million uninsured individuals in our country, and that number does not even include the underinsured.
We are also placed in the uncomfortable position of observing on a daily basis the absurdity of squandering 30 percent of our health care dollars on the last thirty days of life when, in many cases, palliative care is available as the intelligent alternative.
As a profession, we are also sensitive to the fact that the segment of the population that is most negatively impacted by this existing system is a group that does not have political clout; single mothers and their children. More than 8 million children had no health insurance in 2005, according to the latest federal report on the well being of U.S. children. Children who were uninsured were nearly 16 times as likely as those with private insurance to have no ongoing source of care.
Of course, Moore neglects to mention the failures of the Canadian system, or the challenges of paying for a single payer system. He also doesn’t spend much time talking about the single-digit percentage of our nearly $2 TRILLION in health care expenditures that are dedicated to preventative medicine, but, nevertheless, his reality is largely the truth.
So, as the challenge continues, we in health care administration are busy re-arranging the deck chairs while our Federal officials continue to mark time and the uninsured wait hour after hour to be seen and treated in our over crowded emergency rooms, the part of our system that is strained to the breaking point. These people are OUR people, and they need to be treated as human beings, not as cost centers.
Nick,
Congratulations on another insightful post, and on the reference in today’s WSJ. (http://blogs.wsj.com/marketbeat/2007/07/12/the-ceo-blogs/)
It’s a pleasure to continue working with you strategically on the blog, as well as developing graphical and multimedia content.
As to Mr. Moore, one doesn’t necessarily have to agree with all of his positions in order to see the greater truth you’ve hit upon.
Absurd, indeed, that so much of our health care dollars are spent on the last 30 days of life. Certainly, palliative care is an intelligent alternative.
Yet, as long as the so-called “culture war” rages on in the US, and permeates the debate about how to reform the US health care system, end-of-life care, and by extension palliative care, will be relegated to vituperative pronouncements by ideologues quick to weigh in with their own beliefs about what constitutes “appropriate” end-of-life care. The Schiavo case was high-profile to be sure, but unfortunately, not an isolated one.
Why should we expect the public to understand palliative medicine when medical education professionals are split in their views of end-of-life care? A 2002 national survey of Medical Education Deans about end-of-life care in the curriculum revealed that a majority of the deans opposed required courses or clerkships that focused on end-of-life care. And when the work of palliative medicine physicians is equated with social work, it should serve as a stark reminder that palliative medicine remains one part accomplishment for five parts of potential.
Nick,
Michael Moore is good at locating and going medieval on America’s problems. But, he never has a thoughtful solution. In fact, his own health issues were highlighted by Eric Schlosser, another fine documentarian, in Fast Food Nation just a few years ago. Mr. Moore, walk the walk, then I’ll drop my seven bones into your coffer.
There are solutions to this problem though. Moore’s solutions will ultimately favor the rich. When there are lines and waiting periods of months or years for care, two levels of care will begin to form. One will be slow and serve ‘the rest of us.’ The other will be better and permit the wealthy to cut ahead. That is the true story of Cuba.
Stephen Kiernan’s book, “Last Rights: Rescuing the End of Life from the Medical System” is one of the best books addressing the issues of our medical system and palliative care written to date. Bottom line? It will be family and community providing service and philanthropic gifts for the care and service of our elderly and infirmed. Nothing else will be able to deal with the numbers and the costs we will be facing in a very short time.
This is the solution I’ve been developing with PatinaCare. (See: http://www.PatinaCare.com). If we focus health care in the middle of our core communities, we will create neighborhood-centered health care that will be cheaper and easier to deliver because we can utilize existing amenities and services and provide skilled care through home care providers like Visiting Nurse Assiciation. VNA can deliver more efficiently, and therefore more cheaply by focusing their efforts and client base.
Windber Medical Center is ideally located to not only provide in-house services for the community (like the fitness center, or as you mentioned, ‘preventative medicine’), but it’s central location in the center of the small town of Windber makes it ideal for outreach that could be cost-effective and efficient. As you know, Windber began as a coal mining town. It was one of the few that was designed by an architect, planned from the beginning with a hospital (your hospital), and was one of the first towns anywhere that had electricity wired to every home. Windber was born innovative. You are just continuing that legacy. Outreach and delivered care from existing medical facilities can help to alleviate our growing problems.
Nick,
I feel like I know you. Your blog is always a wonderful read.
Donna
Dear Nick,
I am a friend, former student and share your views not only with your brother, Charlie, but with you as well.
Having worked in the medical field for a while, I saw first hand how the insurance companies made a killing while the patients were suffering emotionally, physically and financially.
Let’s take the bull by the horns and tackle this medical mess along with Michael Moore. I salute your efforts.
Sincerely,
Patricia J. Mills
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