How Nate Would Fix U.S. Health Care

I'm not running for President in 2008 but have been thinking a lot about how royally f'ed up the U.S. health care system currently is. Although I do enjoy helping people deal with their kidney disease on a day-to-day basis and can point to numerous instances of success, there are certain cases I am involved with duI'ring which I can't help shake the feeling that I am also helping propagate this ridiculous health care system which is not sustainable in its current form.

Three things I would do to improve the system:

1. Universal Medical Records. I have talked about this on my blog before. One computer information system for everybody. Eliminate paper charting. This would save oodles of dough and improve communication between doctors, resulting in less duplication of expensive medical tests and overall better clinical care. I heard Hillary Clinton speaking about moving towards a universal medical records system recently and I couldn't agree more.

2. Limit care in medically futile situations. One of the reasons our medical costs are so astronomical is that our resources are allocated so poorly. Specifically, we are spending too much money on patients with advanced medical illnesses in a misguided attempt to prolong their lifespan at the expense of a reasonable quality of life, and too little on preventable disease. I can point to numerous examples of this since starting my renal fellowship, the most obvious one being an elderly man who underwent a heart valve replacement surgery and had a very difficult post-operative course which involved, among other things, kidney failure and low blood pressure requiring him to be hooked up to a special dialysis machine which was running 24 hours a day and required the presence of a single nurse to be with this patient at all times. He was on this kidney machine every day, 24 hours a day, for a period approaching 4 months before he expired. I feel guilty when I think about (a) the suffering this patient likely endured over this extended period of time, and (b) the amount of vaccines, antihypertensive agents, and pediatric checkups which could have been paid for with this single individuals' medical bills.

I think most physicians involved in this case probably felt that this had gone on for too long, but for whatever reasons, these concerns were not voiced until the very end. Why did this happen? Some of the fault lies with us doctors: there is a culture of not giving up at any costs, which in a sense is noble, but at the same time our degree of medical sophistication has evolved to the point where we need to realize that just because we can do something for a patient doesn't necessarily mean that it is appropriate. Second, our country has moved too far towards giving the patient decision-making autonomy and away from the traditional paternalistic model during which the physician makes the "best decision" for a patient. This is accomplished in the transplant community--there are only so many liver transplants to go around, for instance, and it is up to a panel of physicians and other health care providers to decide who is eligible and who is not--because the organ supply is seen as a limited resource. At some point, high-priced medical procedures should also be categorized as "limited resources" since our medical funding is not unlimited. Finally, I think another reasons doctors are reluctant to limit outrageous medical spending in helpless medical cases is that they are concerned about the possibility of a lawsuit which could destroy their medical career, resulting in the current practice of "defensive medicine" in which many unnecessary tests are ordered. Which leads me to my next point:

3. Put a cap on medical lawsuits. I agree that we must preserve the right for patients to sue doctors for gross negligence--I would be nieve if I stated that all doctors are altruistic and cannot be held accountable for obvious mistakes such as sawing off the wrong leg or missing an obvious diagnosis of a treatable cancer. However, for the most part doctors are a hard-working bunch who sacrifice a great deal of personal time in order to help achieve a good outcome for their patients, and it really bothers me to see "good samaritans" such as these to be scape-goated and sued. Furthermore, million-dollar lawsuits results in driving up malpractice rates for doctors and health care insurance premium for patients. If there were a "cap" on the amount somebody could sue for, this might help limit these expenses. I know it is impossible to put a value on human life, but at the same time such large sums of money are a huge burden to society.

So there you have it. Three easy-as-pie steps to fix the U.S. health care system.

On a lighter note, GO PATS. They play in the Super Bowl in about an hour.

Here is the all-too-short list of professional sports teams who have won a championship while I was living in that city:

1987 Minnesota Twins
1991 Minnesota Twins
2000 St. Louis Rams
2007 Boston Red Sox
2007 New England Patriots?