Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, March 7, 1994 TAG: 9403080017
SECTION: EDITORIAL PAGE: A-7 EDITION: METRO
SOURCE: By BARBARA BALOWSKY
DATELINE: LENGTH: Medium
Listening to the latest comments from Washington, one would believe that this has become the central question in the debate over health-care reform. Both Democratic (Sen. Daniel Moynihan, D-N.Y.) and Republican (Sen. Robert Dole, R-Kansas) politicians have said in recent weeks that there is no fundamental crisis in the system. Even Ross Perot has joined the chorus, questioning whether major change is needed.
The assumption that has driven the health-care debate to date has been the view that the system is not functioning well - that it is too cumbersome, too costly, too inaccessible. Until recently, it seemed the only people who disputed the existence of a health-care crisis were those with a strong financial interest in maintaining the status quo - insurance and pharmaceutical companies, for example.
But now the leaders who will debate the future of the American health-care system have raised similar questions. To buttress their assertions, they point to lower rates of cost increases for health care. For instance, federal officials predict that the two biggest government-financed programs, Medicare and Medicaid, will cost about $45 billion less over the next five years than projected last fall.
The new skeptics also maintain that for the vast majority of Americans, the only real problems are the lack of portability of health insurance and over-reliance on emergency-room visits. We can deal with the uninsured, they argue, simply by providing them with insurance. Further, they say that the private sector already has alleviated cost concerns through greater use of health maintenance organizations or other, presumably more cost-effective, systems.
A challenge to the notion that the system is in crisis threatens to undermine efforts for comprehensive reform along the lines proposed by President Clinton. America's nurses believe the present health-care system is in crisis, and that only a fundamental change in how health care is thought about and delivered makes sense. A failure to restructure the system in 1994 must be viewed as a lost opportunity.
The present system places the emphasis in the wrong areas. It emphasizes treating illnesses after they occur, rather than on preventing illness from occurring. Indeed, the present system might be called a disease-treatment system rather than a health-care system.
Consider, for example, the irrationality of a system that will reimburse for treating lung cancer, but will not pay for programs that help people stop smoking. Or of a system that generally spends more in the last few weeks of a person's life than is spent during the person's lifetime to provide medical and nutritional advice.
Studies show that for every dollar spent on prenatal care, the nation saves $3 in treating infant diseases. For every dollar spent on immunizations, the nation saves $10. To focus our money on prevention rather than treatment requires a change in how health care is delivered.
Another fundamental problem lies in where health care is provided. The majority of our care occurs in hospitals or physicians' offices. This is because the emphasis is on treatment rather than care, including preventive care. What makes more sense is to provide care where people are - in community clinics, in schools, in the workplace and in the home.
In short, what we truly need is a basic change in how we think about health care and how we provide it. We should create a system whose primary role and goal is to keep people healthy by emphasizing good habits, counseling and support when needed, and personalized education. Such a system also, of course, must provide care for people with disease - but a system that provides only for disease, and fails to prevent it, does not deserve to be called a health-care system.
Yes, there is a crisis in health care. It is not just a financial one that can be alleviated by providing insurance to everyone, or by making minor changes. It is a fundamental crisis that warrants a rethinking of what kind of health care is delivered, where and by whom.
Only by restructuring how health care is delivered can we establish the needed efficiencies in our system and, much more important, have a system that really provides health care rather than just disease treatment.
Barbara Balowsky, a registered nurse, is commissioner on government relations with the Virginia Nurses Association in Richmond.
by CNB