January 13, 2013

A better way for medical care

The United States provides some of the best medical care in the world.

Yet, we lag behind some other nations in the use of technology in medical records. Our system imposes upon its residents one of the world’s highest costs, as a share of gross domestic product. We have one of the highest rates of residents unable to receive medical care. And, without major innovation and reform, we will be unable to produce prosperity for our children and health for our elderly.

These seemingly contradictory facts are not surprising, once one understands how medical care is delivered in this country. The system was designed three quarters of a century ago so large companies could attract new workers but without offering higher wages. Employers provide health care by paying insurers, and insurers pay providers to care for workers. It has produced a patchwork system that discourages worker mobility just as corporations are unable to commit long term to their employees. Our system has also evolved to treat the disease rather than the customer, and ties workers with pre-existing conditions to employers rather than to a better skills match.

The good news, though, is that there are some excellent examples of innovation, especially right here in Clinton County.

The strength and weakness of health care American style is that it rewards greatness. A renowned surgeon or specialist, a highly reputable teaching hospital, or an innovative clinic attracts those who demand the best and can afford it. Excellence is rewarded, and prima-donna professors at medical-research centers encourage it. Often, the general practitioner becomes a mere middleman between patient and specialist. There is a distinctive hierarchy, with medical salaries keeping score.

Our system directs more and more of our medical-school graduates to the more scarce and rarified specialties that garner the greatest salaries to pay off their exorbitant student loans. This bias toward the best encourages excellence, but at a price.

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