US Health Care Debate MIsses the Point

There is little argument that the US health care model needs to be changed. But up to this moment, the arguments going on in congress make me think we are missing the boat entirely. What they are debating is changing how health care will be paid for, and how health care will be distributed. What we need is a fundamental redesign of our health care model, starting with the first day of medical school.

Considering how many years of their young lives they give up, in my opinion, physicians are some of the most under-compensated people in our society, right along with teachers. It takes until the early to mid thirties before a physician finally gets into practice. In the mean time, most of their college classmates have been out earning a living for a decade, investing in their retirement, buying houses, having nice vacations, while the medical residents are subsisting at near minimum wage, barely making ends meet.

And some of their years of training are brutal. During my one year of internship, I had two surgical interns as roommates. They would typically sneak moments of sleep in the hospital for two full days, before coming home for a good night’s sleep (maybe six hours) on the third night.

When I was in college in the 1970’s, the best and brightest of the college students were pre-med. There was a promise of a good income to all who could beat out the fierce competition to get into medical school (less than one in ten would succeed), and put in all the hard years of work to become a trained physician. But for decades now, the insurance companies have been dictating compensation to the doctors, who almost all have to sign on or go out of business. Become a member of their panel of doctors, and they will send you plenty of insured patients, but the doctor will work for what the insurance company determines is fair. The result has been a steady drop in the relative incomes of the very people whom we trust to keep us healthy.

But even worse, is the way that doctors are compensated in our current economy. Doctors are paid for doing procedures. Pap smears, X-rays, tonsillectomies, vaccinations, exams, crowns, root canals. It is way more lucrative to treat a heart attack victim than it is to prevent the heart attack. And that is just wrong.

But insurance companies are only one of the major forces that are influencing our health care system. Let us not forget the influence of the drug companies. The drug companies hit the jackpot when they create a drug to handle the symptoms of a chronic disease that is affecting millions of people. It is way more lucrative to manage the symptoms than it is to cure the disease. When you are cured, you no longer have a need for their drugs.