President Obama, where is your promise about transparency and accountability in Obamacare?
A major problem in the healthcare system is the lack of transparency and accountability. It has been unchecked for a very long time.
Both primary and secondary stakeholders act in their self-interest. These stakeholders have had ample opportunity to be non-transparent and non-accountable. All the stakeholders have abused the healthcare system.
I hit a nerve with my last blog “Patients And Physicians Must Control Costs”. Multiple readers responded with the usual comments:
“Patients are not smart enough to handle their own healthcare dollars.”
“Your basic idea makes sense, but in reality I doubt that a patient knows enough to make intelligent medical/financial decisions, because there are too many unknowns and variables.”
“Physicians over use the fee for service system in order to make more money.”
“If a physician tells a patient that there is only a 1/10,000 chance that an MRI will yield something useful, if the patient doesn’t have to pay for it, the patient wants the MRI.
Patients (consumers) must be taught and motivated to manage their own healthcare dollars. Patients’ choice Read more »
*This blog post was originally published at Repairing the Healthcare System*
Medical schools are traditionally ranked on criteria like research funding and technological innovation. These rankings are highly significant. A place on the U.S. News‘ annual “Best Medical School” list is a coveted spot indeed.
So that’s why there was some media attention paid to a recent study from the Annals of Internal Medicine, which ranked medical schools according to their “social mission” — a phrase that defines a school’s commitment to primary care, underserved populations and workforce diversity. Using this new criterion, some of the traditionally high ranking schools fell significantly. Read more »
*This blog post was originally published at KevinMD.com*
I was looking through an article in Time Magazine recently and came across an article about healthcare reform. It spoke of the daunting task ahead and went through a list of the people at the table in the process of creating change. The list included politicians, hospital corporations, pharmaceutical companies, insurance companies, and lobbyists from certain large special-interest groups. Notably absent from the list was physicians and “normal” patients. I commented about this in a conversation with Val Jones, MD, and she said: “If you aren’t at the table, then you’re on the menu.”
She’s right. Up to now, the interests of the people who matter most – the doctor and patient in the exam room – were largely unheard. Folks said they knew our needs, but they all had their own agendas and so often got it wrong (either out of ignorance or out of self-interest). Even the organizations that are supposed to represent my needs, the AMA and the specialty societies to which I belong, are not composed of folks who spend most of their time in the exam room; they are people who have either retired to spend their time in Washington, or are full-time smart people (they know lots about other people’s business). There are very few people at the table who regularly see patients. There are also very few who represent patients without a particular axe to grind (elderly, people with chronic disease or disabilities).
But healthcare is about what goes on in the exam room. The entire point of healthcare is health care; it is about the care of the patient. It isn’t about the business, the drugs, the delivery system, or the insurance industry; it’s about optimizing how the system makes sick people better and keeps better people from becoming sick. Everything else is a means, not an end.
But those of use who are in the exam room are soon to be served up on the menu for the sake of political gain and special interest clout. They may or may not have a good plan, and they may or may not have good intentions. But they definitely do not have an understanding of what really goes on and won’t be affected much by the decisions they make. They are serving up a dinner of food they don’t know about and they won’t have to eat what they cook. How can they make good decisions?
A step in the right direction would be to listen to bloggers. As opposed to the lobbyists and pundits inundating Washington, we actually do healthcare. The doctor and patient blogs on the web represent the interests of the people who are in the middle of the healthcare universe. This universe doesn’t have Washington DC at its center, it has the patient and those who care for him or her.
A good parallel is the crisis in Iran. There are reporters and politicians who say they know what it’s all about – and in some ways they do – but the voice of the people living in Iran are crucial to understanding what is going on. Why are there riots? Ask a rioter. Was there rigging of the election? Ask someone who was there to witness the process. The people who are on the ground should always be listened to. They don’t give the entire perspective, but getting a true perspective is impossible without talking to them.
Don’t just listen to me; I represent a specific point of view, and don’t represent that of patients or specialists fully. Don’t just listen to patient blogs, as they often don’t have a clear understanding of the business of medicine or the complex medical realities (although I know some of them do know an awful lot). We need to force ourselves to the table. We need to give perspective that has previously been invisible.
Blogging matters because it gives perspective that could never come from anywhere else. Blogging is the journalistic equivalent of democracy, giving the average person a chance to make their voice heard.
In July, a group of us medical bloggers will be going to Washington to do what we can to make our voice heard (thanks to Val Jones’ hard work). Maybe it won’t make a difference; but at least we won’t be invisible any more.
*This blog post was originally published at Musings of a Distractible Mind*