May 14th, 2012

Podcast 155: What’s wrong with U.S. healthcare and what will save it?

Dr. Arnold Relman, longtime observer of the U.S. healthcare system and editor emeritus of the New England Journal of Medicine, proposes two major reforms: First, private insurance companies should leave the healthcare field, and second, physicians should organize into multispecialty practices.

His proposals, just published in BMJ, grow out of his alarmed observation — some 30 years ago in the NEJM — of the rise of the “new medical-industrial complex.”


BMJ essay (free abstract)

NEJM 1980 article (free abstract)

One Response to “Podcast 155: What’s wrong with U.S. healthcare and what will save it?”

  1. Charles Beauchamp MD, PhD says:

    What about:

    1) “facility codes” being used by hospitals and especially health care systems to charge very high prices (e.g., 500 dollars for an outpatient urine culture) for lab tests on outpatients being seen in hospital/system owned practices?

    2) private practices in rural areas where one might be the only internist available in a multiple county area. There are no “groups” to join. There is no viable

    3) the buying up of private practices by smaller hospitals and the increases in fees that result from the hospital system being a monopolistic provider of care.

    4) the lack of cost accountability of pharmacies where the cash cost of meds varies widely from pharmacy to pharmacy

    5) the importance of physicians knowing they can charge for “face-to-face” education time IF they truely provide a patient education, instruction and self-care advice AND an “out the door” after visit summary of those specifics.

    My solution as the only real primary care general internist within a three county area in northeastern NC:
    1) get labs done at LabCorp, a reasonably priced reference lab
    2) draw the blood myself while doing face-to-face education
    3) use a renovated portion of my house (mortgage 801 dollars per month) as office space in the downtown section of a town having a small hospital three blocks away
    4) create a “buying service” for patients whereby they (and their insurance companies) get the best price on insurance, meds, tests, consults
    5) implement detailed patient education, instruction and self-care plans connected to continuity of care
    6) utilize a physician-friendly, concept-driven EMR that connects to a state HIE that will accept annotated problem lists, patient instruction notes, disease classification data
    7) utilize evidence and experience based interventions and intervention sets (e.g., maximal medical therapy for CAD/angina pectoris) that account for the microvascular aspects of the patient’s presentation
    8) have ongoing central goals of the practice be: clinical prevention of significant adverse clinical outcomes – strokes, heart attacks, congestive heart failure requiring hospitalization, progressive renal insufficiency, sudden death, diabetes onset, diabetes complications, reactive airway attacks, rhinosinusitis requiring antibiotic rx, debilitating menopausal transitional symptoms, pain requiring narcotic rx, disabling chemotherapy complications, total knee replacement surgeries, resistant to treatment major depression, depression as a complication of medical illness, recurrent vascular headaches, quest for secondary gain, progressive cognitive decline with schizophrenia, use of Seroquel as an anti-depressant, anti-anxiety & pro-sleep agent, disabling bipolar II symptoms, recurrent visits to the ER, cystic adult acne, non-healing wounds, lack of a holistic approach to care, lack of catastrophic health care coverage.

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