Physician’s perspectives on universal health care
Massive media campaigns and scores of political pundits have put health care under klieg lights, trying to persuade Americans of the value or the horrors of health care reform and universal insurance coverage.
Yet, there’s more to medical care than the debate going on in the halls of Congress or the barrage of TV commercials and talking heads, say some local physicians and medical researchers. Change is not only coming in health care, it’s already here, they say.
Wellness standards and quality of care have been debated for decades, and one clear universal definition hasn’t emerged, says Alexander A. Stemer, M.D., an infectious disease specialist and founder and president of Medical Specialists Centers of Indiana.
“It’s difficult finding standards that everyone agrees to,” Stemer says. “In 1997, for example, hormone replacement therapy was thought to help lower the risk of osteoporosis and heart disease in post-menopausal women. Then in 2005, we received data that HRT can cause heart problems in some subsets.”
However, Stemer says, Medicare has established standards for 140 health issues that can be measured, including blood pressure, cholesterol and blood sugar levels. The federal health insurance plan for those aged 65 and older also now rewards medical practices that adhere to those standards, he says.
In addition, Medicare is often the first to cover new services. The federal insurance plan was the first to cover deep brain stimulation for the treatment of Parkinson’s disease and the use of stents or grafts to repair aortic aneurysms.
Medicare also identifies treatments that shouldn’t be covered, such as the use of an anti-cancer drug that has more toxic than potentially beneficial effects. Although commercial plans also attempt to deny coverage for such services, they meet with varying degrees of success.
Medical research over the past half century has greatly improved the human condition, according to Dipika Gupta, Ph.D., lead researcher and associate professor of biochemistry and molecular biology at Indiana University School of Medicine-Northwest on the IUN campus in Gary.
Gupta and her colleague Roman Dzarski, Ph.D, are studying genes that help the immune system fight off infections. The researchers found the genes in their lab at IUSM-NW and are studying the genes’ effect in mice.
Research indicates these specific genes’ proteins may be linked to the human body’s reaction to inflammatory diseases such as arthritis, dermatitis and asthma, she says.
“We are looking at what happens when the gene is absent or stops working,” Gupta says. “When we have completed studies with mice, we will then begin human studies.”
New medical procedures and devices are helping people have longer, more productive lives, says Anton Thompkins, M.D., an orthopedic surgeon specializing in spinal care with Lakeshore Bone & Joint Institute in Chesterton.
For example, surgeries such as hip replacements that once involved large incisions and massive restructuring now can be performed with minimally-invasive procedures, Thompkins says. Delicate spinal surgeries can also be done through small incisions and using robotic technology only recently available.
“Patients heal quicker,” he says. “In sports medicine, there are also new implants that allow the surgeon to do more complex cases.”
Thompkins says that Congress and the President “are driving for saving money, for spending less money. But new technology is expensive and the patient does better.”
Advances in medicine should be measured by the quality of the patient’s outcome rather than the money saved, Thompkins says. “It’s the speed of recovery and the degree of results the patients feel. This should not be based on accounting, but on patient outcomes.”
However, money will continue to figure in health care and in people’s access to it, both physicians say.
Medical practices that treat Medicaid patients lose money because of low reimbursements, Thompkins says. “With Medicare, we break even and with private insurance, we make money.”
And making money in a medical practice doesn’t mean doctors are in the upper income brackets, he says. “We pay nurses and other personnel’s salaries. We pay for utilities and equipment.”
There is a risk-reward dynamic in practicing medicine, as in any business, Thompkins says. “When the risk of practicing medicine outweighs the rewards, doctors will choose not to practice. There will be fewer doctors.”
Studies show that within the next decade, the nation will experience a shortage of physicians. In Indiana alone, there will be about 3,000 fewer doctors than will be needed.
In addition to fewer physicians, the proposed national health care reform will swell the ranks of patients able to access care in a physician’s office rather than the emergency room, Stemer says. The ERs are where many of those without health insurance go for care.
In Lake County alone, 15 percent or about 75,000 of the 500,000 residents currently don’t have health insurance, but will under the proposed legislation, he says. Across the nation, 32 million more people will have health care coverage by 2013 or 2014 if Congress and President Obama come to an agreement, Stemer says.
What that means is there will be more patients than the available physicians can possibly treat, he says.
“For example, there are 10 providers of dermatology in Lake County. Each can see 5,000 patients each year. How many of those 75,000 who will now have health insurance will need dermatology services, with acne, possible skin cancers? Maybe 20,000,” Stemer says.
“If it now takes several weeks or a month to get an appointment at your doctor’s office, it will take more than three months if you call between Jan. 1 and March 31 of the first year this goes into effect,” he says.
“Right now, we’re dealing with H1N1. If you don’t feel well and call your doctor’s office, they’ll probably say they’ll squeeze you in,” Stemer says. “What happens when 75,000 more people are trying to access care from 100 to 200 doctors? You’re going to be told to go to the ER. We’ll then have equity in health care. We’ll trade patients making ER visits, and the costs won’t drop. This process won’t save money.”
In fact, he says, if the proposed health care reform passes, “taxes will rise or the dollar will be devalued. Someone has to pay for it. What’s going to happen is that people are going to have to accept less care.”