Saturday, August 30, 2008

Fifteen days of blogging for health care reform: Where do we go from here?

Guest post by Skylanda.

If you’re still with me, fifteen wordy days later, you may feel buried beneath an avalanche of priorities and issues and complexities. Out of a whole heap of information, there is always the lingering question: where do we go from here? What conclusions can we make from all this quagmire of complication and controversy?

So here’s the post-game, the recap, the proverbial twelve steps to health care reform, not so humbly opined from the dozen-plus posts above. Without rehashing the minutiae of detail from every post over the last two weeks, these are the overarching priorities that I believe could make substantative, transformative health care reform a reality in this decade, in this country.

* Single payer health care. Health care is a public good, like roads or schools or national defense, with a unique requirement of portability; it is the obligation of every soul living on our soil to pay into it in the proportion to which he or she is able, in order that he or she may draw out what is needed for the maintenance of their health.

* Structuring reimbursement to best motivate service without compromising quality, with an eye toward equalizing procedural and non-procedural reimbursement and drawing quality providers into the field of primary care.

* Prioritizing funding and services toward maximum gain per dollar spent (especially in considering preventive care versus heroic end-of-life interventions), with the caveat that this does not release us of any obligation to care for the most vulnerable populations among us.

* Minimizing barriers to care for the most at-risk populations in order to prevent costly delays in service associated with neglect of care in those groups.

* Market-based and legislative pressure to bring pharmaceutical research & development in line with the goals of social good, with an emphasis on innovation over continued production of me-too drugs.

* Using evidence-based medicine as a means of exerting cost-control measures. We have the means to know what works, and to know what works at the most efficient price: time to put this to work for us at the individual, system-based, and legislative levels.

* Reforming medical education to emphasize clinical over theoretical focus, humane treatment of trainees, and capping student debt in return for expectation the physicians will make generous but not unreasonable incomes throughout their career.

* Reforming the medical malpractice to systematically emphasize patient safety and create a means of compensating patients harmed by medicine without resorting to the bad-luck lottery of the lawsuit.

* Drawing on the immense portion of the governmental budget and national GDP already dedicated toward health care to reformulate a fifty- to one hundred-year plan to fund, streamline, and maintain a sustainable health care system at a per head investment comparable to that of other developed nations.

* And finally, understanding that health care insecurity is an untenable impingement on the freedom that Americans value so highly, and that health care security divorced from private employment-based insurance is a key to maintaining a healthy, open market for small-scale capitalism to flourish in.

The work of today’s generations - the generations that opt out of health care through their twenties, that shoulder the tab for the nation’s health through their productive years, and that will very likely live to see the useful end of that nested safety blanket known Social Security if we do not steer this ship in a very different direction - the work of this generation is to meld the brilliance of American innovation and ingenuity with the pragmatics of the collective good to form a health care system that none other can parallel. We can do this. It has been eons in coming, and the shoulders of giants are ripe and ready for you to stand on.

You may have been tinkering on this issue for years, or you may new to the playing field. If you have been involved in the push for health care reform for weeks or months or decades: good on you, keeping fighting the good fight. If you step gingerly around the questions of whence to start and who will pay for this and whether you really know enough to put that first toe in the water, understand this: as a famous person once said (and many have since quoted) - if not now, then when? If not you, then who?

It starts with November 4th and every day that comes between now and then. It starts the next time you see your doctor and ask whether he or she considers cost control when prescribing your medications. It starts with a letter to the editor, a call to your state representative next time a health care bill arises. It starts when you tell your story, when you speak up, when you talk out.

It starts now, today, here. With you. Let the work begin.

Cross-posted at my blog, Loose Chicks Sink Ships. Please note that all references to patients have been altered and/or fictionalized to protect the identity of those individuals.