How delusional is my solution to the health care crisis?

I was having breakfast today with one of my alumni who is in the MD-Ph.D. program at Northwestern’s Feinberg School of Medicine, and I passed my idea by him. He actually said this made sense, so I figured I’d float it past the crew and see what everyone else thought.

I’m not an expert on this – by any means. I’ll take criticism on my ideas without taking it personally. I would welcome other opinions.

I also choose not to participate in the 24-hour television news craze that sucks in so many. I really think it helps reduce my stress and (ironically) makes me healthier to not sit in front of the boob-tube and go the the repetition news show of repetition.

The Bilhorn Health Care Plan

1. Primary Care (defined as basic preventative maintenance) is provided for all US Citizens and registered foreign residents.

Ask any medical student where the money is at in the health care system, and it’s in secondary care. That’s not rocket science. We can say our system “is the best in the world” because what it does is provides incredible care to those who can afford it and when you have the means, it is great. Really, it is.

But it’s great because it follows the money trail and when you don’t have money you can’t get on the trail.

Then you can die of dysentery – like in Oregon Trail.

(Or you can die by eating 984 pounds of buffalo meat in a single sitting so none of it goes bad.)

So we need to somehow get primary care back as the overall focus of health care in the US. That is the basic premise of my plan.

Why do this? Two reasons – one obvious and one not so obvious.

The obvious reason: People need to go to the doctor regularly. This is simple. People have at least an annual visit to their physician and find out where they are healthy and not so healthy, and regularly address those issues.  If we really wanted to put some teeth to this, we’d actually revoke health care privileges for people who, year after year, repeatedly do not go to the doctor and do not address their  health issues and simply then receive a substandard plan. It’s a “use it or lose it” philosophy.

But I’m guessing that won’t be popular. At all.

The not-so-obvious reason: We need to create more market opportunities for primary care physicians. They are swamped and overwhelmed. My medical friends tell me that the primary care physicians that are happy tend to be in rural areas and know their patients over a longer period of time. Most everywhere else – not so.

The money is in secondary care, and to pay for medical school you need to make money to pay back your loans. Government spending in this arena could actually create a market that isn’t currently attractive and medical schools would pump out more primary care physicians.

The trick on this is to define primary care very, very precisely.  I don’t know how to do that. Anyone wanna help?

2. Exercise programs are included as preventative care, and funded under primary care. Why are we so unhealthy as a nation? One big reason is we don’t exercise. This would help stimulate another area of health in our country and we’d spend money on more preventative maintenance that would allow for us to actually cut costs long term. This is cost savings that won’t be realized until 20-30 years down the road, but we do need to get substantially healthier as a nation.  We need to create a culture of health in our country – and expecting people to work out would be a great thing for our country.

3. Somehow the healthcare program would create incentives for nutrition. How can we actually eat healthier as a nation? I’ve been convicted of this and am being more intentional to fit 5 fruits and vegetables in my diet every day. It’s a start, right?

But spend any time in a low income area, and nutritious food isn’t nearly as accessible or available to the greater populous.  One of the activities I’ve done with my students when I’ve lived in low income areas is to make observations at the grocery store. They are shocked to see no skim milk, over ripe produce in small quantities, and everything pre-packaged so it can have a long shelf life.

Conversely, taxing unhealthy food enterprises (pub-grub, fast-food, and even my beloved Chicago-style pizza) should probably happen as well. Kinda like how we have certain gas mileage standards for cars? Maybe we should do the same for restaurants. That will NOT be popular at all.

But neither is broccoli.

Businesses won’t start in places like this because there are no incentives for start-up enterprises. The Libertarians will hate me for this, but sometimes government must step in to create a market that will aid the overall public interest.

Take the example of a lighthouse: how in the world is it profitable to run a lighthouse? People will take advantage of it and use it, but will anyone actually go and pay for it? That’s where licensing and other fees go to actually pay for people to run the lighthouse.

In the case of exercise, nutrition, and primary care, we are failing as a nation as we are becoming more sedentary, obese, and getting unhealthier every day.  I never thought we’d come to a day where we had to incentivize personal health, but we are here.

I know I’m oversimplifying the issue, but I’d appreciate hearing your thoughts.

1 Response to “How delusional is my solution to the health care crisis?”

  1. 1 Robert September 28, 2009 at 8:01 pm

    I like your ‘use it or lose it’ thought. It could be like a warranty. Like if you bought a car and didn’t change the oil regularly – the manufacturer would not replace it when it seized. You have to show that you did proper maintenance.

    Make it so that everyone pays into a system that provides all general care and if you don’t visit regularly and listen to doc’s orders you don’t have access to secondary care (whether that is private or public). Say you have a heart issue, but unless you have been certified by the primary as a regular visitor and good patient that heart med or surgery is on your dime. Though this is starting to sound a little like an HMO, it would be different.

    The rest of it sounds like some good ideas, but not really a ‘program’. Unless eating brocolli is your program.

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September 2009

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