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The “Free Stuff” Of Healthcare Reform

It happened. Guilty. I confess. Reading about Dr. Berwick’s recess appointment to lead the Centers for Medicare and Medicaid Services (CMS) induced me to watch a Fox news clip. Gosh, I feel bad about it. It felt good, though.

Patients — that’s you and me — should know that CMS controls doctors, nurses and especially hospital/practice managers. They are ten times more scary than the radar patrol car on the highway.

Dr. Berwick likes the British system of healthcare delivery. In Europe healthcare is free, and everyone likes free stuff. Free stuff happens all the time, doesn’t it?

In Cambridge, Mass — at Harvard — free stuff for all seems a plausible tenet. There must be a lot of coffee shops and free time in Cambridge. In the real world — on Main street, on the farm, in the factory, or really everywhere other than college — people know getting something for nothing is fantasy.

It hasn’t happened yet, so my Dad’s advice about not worrying too much about future events still holds true, but Dr Berwick’s recess appointment to lead the all-controlling CMS has the potential to make caring for patients even more challenging. Yes, more regulations, longer EMR notes with a really careful review of systems, and less pay to doctors will surely improve patient care. Scary indeed. 

But it’s good for the heart to be an optimist. So here goes:

A Healthcare-Reform Optimist’s View

It is true that doctors engender little sympathy. Too many still see us as Mercedes-driving elitists. Our hourly wage is rarely quoted.

A physician’s primary goal is to provide patients with the best possible care, not just because it is right to do so, but it is also a validation of our self-esteem. This is human nature. However, delivering the best care is often really expensive. Not just “rescue medicine,” as Dr Berwick calls it, but regular medicine. Things like an MRI for an orthopedic problem that really hurts, or catheter ablation of recurrent but non-life threatening SVT, or even a “simple” pacemaker for symptomatic age-related slowing of the heart beat.

The optimist believes that if favorable healthcare delivery reform is to happen, it will not be because it is better for doctors. Rather, cessation of farcical policy decisions, like the Harvardesque notion that something can be had for nothing, will come as a result of an uprising of the people. As in the majority of people who live in the real world.

Pragmatic regular folks, otherwise known as the majority, realize there are consequences of free medical care. Like when your shoulder hurts and the doctor’s appointment is free, but in three months. Or when the chemo that really works best is too expensive. Or, that two-lead ICD will be just fine for your heart. Or, your AF is really not that symptomatic, surely not enough for the 100,000 dollar ablation. This list is infinite.

May I believe in the possibility that if healthcare continues at this trajectory, the “people” (as in “we the people” or the majority) may allow for favorable healthcare change — like it is supposed to be in a democracy. But I am a dreamer.


*This blog post was originally published at Dr John M*

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