Health Care Reform: Status Report

As those of you who have been reading my various entries over the past 18 months may have noticed, I have been a bit heavy on the U.S. health care debate and light on the endocrine issues.  I apologize to those of you who are weary of hearing anything more about health care , but for me as an endocrinologist who cares for many patients with chronic medical conditions, particularly those with diabetes, having a first rate health care system is important; it doesn’t matter how brilliant a physician I might be if my patients can’t afford to get the services they need or to buy the medications they need.   Anyway, I wanted those of you who may be skeptics about the  benefits of health care reform as proposed by President Obama to check out an op-ed piece that deserves attention.  The article was written by Paul Krugman, the Nobel Prize-winning economist and entitled “Health Care Reform Myths,” and published in the New York Times March 11, 2010. I agree with most of what Dr. Krugman wrote and I liked the fact that he kept the rhetoric reasonably apolitical.

My Westminster College Lecture

As long as I’m writing about health care, I might as well tell you that the other day, I gave a lecture at Westminster College in Fulton, Missouri.  Fulton is only about 25 miles from my home town, Columbia, Missouri, and the county seat of Callaway County, named for James Callaway,the grandson of Daniel Boone.  Fulton (population 13,000) is  known mostly for having 2 excellent colleges, Westminster and William Woods, and for the Winston Churchill Memorial and Library(WCML).  The WCML is located on the campus of Westminster College and is the site of Churchill’s famous “Iron Curtain” speech.  Many world leaders have visited the site and have given important speeches, including the one by then Soviet President Mikhail Gorbachev who announced the end of the Cold War and the fall of the “Iron Curtain.”  My not yet famous speech in Fulton was entitled “Chaos theory in action: The U.S. health care system.”

I spoke to a class of about 35 students in a course that examined a wide range of controversial contemporary issues.  I have no idea why the course director, Professor Margot McMillen thought U.S. health care might be a controversial issue.  Anyway, I tried my best to provide the students with a framework for understanding the current U.S. health care reform debates rather than focusing on my opinion on how to fix the problems.  I tried to keep the discussion apolitical which, I have learned, is the best way to get people on both sides of the debate to listen.  I focused primarily on describing the cost-generating components of the system.  I divided those components into 2 large categories, government and non-government.  On the government side was Medicare, Medicaid, U.S. Public Health Service (Indian Health, Etc.), Veteran’s Administration, Military (active duty members and their families), and miscellaneous (e.g., Community Health Centers).  On the other side was private insurance and self-pay (this included out-of-pocket health care expenses for even people with insurance or Medicare or Medicaid).

For each  component I tried to describe its history and current status, including costs and my take on its weaknesses (e.g., difficulties that many people on Medicaid have in finding physicians willing to see them).  I then tried to address what most experts feel are the 2 most important problems with the current U.S. health care system, lack of access and high and ever increasing costs.   By the end of the hour, I think most of the students understood enough about the issues to critically critique the various health care proposals that  bombard us if we read newspapers, watch television, or listen to the radio.  Apparently, each student will be required to write a paper about the lecture.  If Professor McMillen will give me permission, I want to read the students’ papers.  Did I actually teach them anything or do I need to “go back to the drawing board” to find a better way to educate people about the U.S. health care system?  Maybe, as the title of my lecture suggested, I should just give up trying to bring order to chaos?

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