Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, February 13, 1994 TAG: 9402140319
SECTION: EDITORIAL PAGE: B3 EDITION: METRO
SOURCE: NEWELL FALKINBURG, M.D.
DATELINE: LENGTH: Long
From any analysis, American medicine is the best in the world. The notion that we have a crisis on our hands because we are No. 3 in the industrialized world in neonatal mortality and other such statistics has virtually nothing to do with the quality of the American medical health-care system.
That fact may be true, but it is not because of our system of health care. It is because the United States has a basic societal problem. It is because the disadvantaged in this country, a huge segment of the American population, are virtually unable to access any part of the American dream, let alone access the health-care system.
American medicine attracts the best and the brightest in the world. They come here to study, to train, and to learn. Those who return home take with them the best that is available in the world.
And where do the wealthiest, most privileged and most sophisticated patients come for medical treatment? To the United States. I do not think this is because we are inferior to other countries in the world. You do not see these patients beating paths to Canada, England, Scandinavia or any other area of the civilized world.
They come to the United States - to the best health care in the world. For it is American medicine that is responsible for an astonishing drop of 36 percent in overall mortality since 1950, for the fact that heart disease is down by 50 percent since 1970, and I could go on and on. We make no apologies to anyone for our quality. We are the best, and I am darn proud to be part of it.
However, it has become clear that we dohave some problems, access to care for all Americans, and skyrocketing health-care costs and health-insurance premiums being paramount.
I have heard a lot of criticism of hospitals and physicians for the rapidly rising costs of health care. I would like to suggest that we look to the American people themselves for a solution to some of these issues.
Many people are actually overinsured, in that they pay virtually nothing for any part of their health care. They do not appreciate what they have. They overuse the system - taking no responsibility for themselves.
They access the health-care system in absolutely absurd ways; through emergency rooms, for example, for trivial illnesses. They access the system in the most expensive ways. They do not have personal physicians, and they simply don't take care of themselves.
Look at tobacco use. It is the single most preventable cause of death in the United States of America. It is a major risk factor for diseases of the heart, blood vessels, chronic bronchitis, emphysema, and cancers of the lung, larynx, pharynx, etc. The annual smoking-related health-care expenditures by the federal government in 1984 were $4.2 billion in Medicare and Medicaid payments. One in five deaths in the United States of America in 1988 was caused by cigarettes; 32 pecent of all cancer deaths, 21 percent of coronary heart disease deaths, and 88 percent of chronic lung disease deaths.
Look at alcohol usage. Alcohol dependency and abuse are an enormous public-health problem in the United States of America. It generates an awesome demand on the health-care system, to say nothing of the value of reduced or lost productivity in the workplace.
Again, the statistics are telling. Twenty percent to 40 percent of the people in general-hospital beds are being treated for complications of alcoholism. In 1988, the proportion of traffic-crash deaths that were alcohol-related was 41 percent. Sixty percent to 90 percent of all liver disease is alcohol-associated.
The direct treatment costs for alcoholism amount to $13.5 billion a year. Most of this treatment is administered through general medical care.
I think there is sufficient blame to go around. Perhaps we all need to shape up a bit and get our acts together if we are really going to solve America's health-care problem. However, I do not believe these problems are unsolvable. What is crucial is that we do not destroy what is good and best in our system in our zeal to fix its ills.
I am reminded of a story I heard Newt Gingrich tell in Washington several months ago. He described a young man who was driving in a country town in the American Southwest. On his left, at the side of the road, was a large billboard. Embossed in bright, almost iridescent, large red letters were the words ``Veterinarian/Taxidermist.'' In small italics below, it read: ``Either way you get your dogs back.''
So Mr. and Mrs. President, our disagreement is not about whether medicine has some problems. Rather, we are concerned with the condition it will be in when it is returned to us to use in the care of our patients.
I want to emphasize thatI am trying not to be a naysayer. We are all looking for a cure for our ailing health-care problems. But we must evaluate any proposals objectively as they are brought before us, and I see here the biggest social initiative since the New Deal.
The current Clinton health-care proposal is bigger than FDR's initiation of Social Security a half-century ago, and it seems to me to be overlaid with bureaucracy - more paperwork, not less. Our government of has never been known for cost containment.
Virtually everyone agrees that health care in the United States is too expensive. But administrative costs account for nearly one quarter of all health-care costs. Physicians' fees constitute less than 20 cents of every health-care dollar. Couple this with the hassle factor, and it is no wonder health care is expensive. In my practice, if it is not an insurance company looking over my shoulder, it is a bloody lawyer!
I suggest we use a "health-care litmus test" to evaluate any reform proposed to us to use for our patients. First, will the patient be able to choose his physician? Second, will we physicians be able to provide necessary, effective and efficient care without undue restrictions on our clinical judgment?
If the answer to these two questions is yes, then we physicians should be all for it. We would like to suggest that we evaluate any of these issues that come before us in terms of our patients, for what is best for them will ultimately be what is best for medicine.
\ Newell Falkinburg, M.D., is president of the Roanoke Academy of Medicine. This is excerpted from his inaugural speech last month.
by CNB