Minor Thoughts from me to you

Earlier today, the American Academy of Physician Assistants issued an urgent Action Alert:

In a speech before the American Medical Association today, President Obama once again restated his commitment to building America's primary care workforce of "physicians and nurse practitioners" - omitting PAs from the discussion.

Please contact President Obama today. Let him know that PAs are listening- and that we are gravely concerned that we're not hearing a similar commitment to physician assistants.

PAs are the future of health care, and must make their voices heard. Contact the President today with a special message: PAs are a Critical Part of Health Care Reform.

I knew about it because a friend -- who's studying to become a PA -- emailed me and asked me to contact President Obama. She asked me to emphasize how important it was that PA's be part of the solution. Here was my response.

I can't do that. I disagree with the entire premise of healthcare "reform". The AAPA and Congress are both operating on a flawed assumption: the idea that it's even possible to create a plan that works for all Americans. It's not.

No one person, or group of people -- no matter how smart -- has the ability to create a health plan that meets the needs of 300 million unique individuals. No one group has enough information to make good decisions for everyone. Every patient has different needs, different backgrounds, different abilities, different family structure, different reactions, and different prejudices. I know you've seen this in your experiences in healthcare.

Through family, through friends, through my wife and through my job, I've heard a lot of stories about healthcare. One thing I've learned is that doctors (and PA's) have trouble coming up with a treatment plan that works for one patient. Often, the patient and the doctor have to work together over a period of time to figure out what works best for the specific condition and patient. How much harder -- how much more impossible -- is it to define a plan that works for everyone?

The necessary knowledge doesn't exist in one database, one field, one speciality. It's dispersed through many different people, each holding incomplete and sometimes seemingly contradictory information. I'm not just talking about medical information either. Each patient has a different willingness to undergo treatments, a different tolerance for discomfort, and a different preference for how long to continue treatment. How can one committee, how can one plan, possibly work for all people?

The answer is not to centralize decision making in Washington, D.C. or even in Madison, WI and Albany, NY. The answer is to give each patient, each doctor, each PA, the full freedom they need to reach the decisions that work best in the individual circumstances.

In the end, it's the patient that must be free to make all of the required decisions. Doctors, nurses, PAs, and healthcare organizations ultimately listen to whoever is paying the bills. Right now, that's Medicare, Medicaid, and the insurance companies. As a result, healthcare professionals are far more responsive to the desires of big government and big insurance -- not to patients. The solution is to return control to the patients -- not to take it further away from them.

Here's an interesting statistic (page 417): in 1960, 55 cents of every dollar of health care was out-of-pocket. In 2003, it was down to 16 cents. Today, the rest is paid through taxes and insurance premiums. And all of that insurance hasn't saved anybody any money. Healthcare costs today are 80% higher than they were in 1960. Put a different way, patients are only paying 16% of the costs out of pocket but the total costs have skyrocketed. That hasn't exactly turned out to be a great deal.

I feel very strongly that we'd be much better off if we started paying for healthcare the same way we did in the 1960s. If patients pay more out of pocket at the place of service, they'll ultimately get higher quality care. Overall costs will drop (through increased price transparency and competition) and patients will save money in the end.

And, yes, there will always be people who's injuries and illnesses exceed their financial resources. But they would be better served through block grants than through government plans, payments, and rationing. If they need financial assistance, give them extra finances. But allow them to control how, when, and where they're treated.

That's healthcare reform that will truly change things. Trying to create a nationwide plan by getting all of the special interests involved will just result in more of the same failed healthcare policies that we've seen over the last 20 years.