Medicine is A Moped Instead Of A Mercedes
“The high cost of medical care” trumpets like a clarion cal
throughout the nation. Medical costs are included in the medical curriculum as a
factor in the treatment of disease, whereas the proper course to teach embryo
physicians would comprise the ethics and obligations that doctors owe their
patients. Doctors are now encouraged to prescribe cheaper copies of medications
whereas they should be encouraged to prescribe what they believe to be the best
medication. Pharmacists must by law dispense generic copies pf drugs unless
physicians detail explicitly on the prescription blank that they want brand
names.
There is a contest between hospitals to shorten the stay of
patients to an irreducible minimum (which keeps getting smaller) in order to
make money, or at least come out even with state reimbursement for a hospital
stay. To make the system work (it is called Diagnosis Related Grouping or DRG)
Dr. Shirley Mayer, Commissioner of Health for the State of
Industry, itself falling on hard times, has come to realize
that its medical insurance contracts with employees are no longer inexpensive
fringe benefits, but sizeable commitments that cost real money, is joining the
ranks of those exerting a downward pressure on medical costs. Labor supports
industry in attempts to lower the costs of medical care.
Home deliveries by midwives are becoming a lively topic of
conversation and whispers of legislation in this direction are heard in the
legislative chambers.
What all this boils down to, when all the decorative
adjectives are laid aside, is a diminution in both quality and quantity of
medical care per dollar spent. A medical moped instead of a medical Mercedes.
What does this trend mean to the patient?> It might mean
that there will be fewer solo practitioners; and those that exist will not be
well equipped to perform basic studies or procedures on the sick patient.
Concomitantly there will be an increase in the number of doctors practicing in
groups and a marked increase in the
number of doctors who will be dependent on a hospital for income, either as salary
or because their offices are hospital based, or they lease offices that are
owned by for-profit hospital holding companies. Thus the independence of the
practitioner will be lost. More will be on salary than ever before and this
loss of independence skews the system of checks and balances that the nation
still seeks.
It would seem that nurse practitioners and paramedics,
currently enjoying a successful run as television heroes will work their way
into the practice of medicine. Midwives will deliver babies at home; and chiropractors
wedded to the cult that disease processes can be ameliorated by adjustment of
appropriate vertebrae to relieve distress of affected nerves, will flourish and
receive the blessing of third party payers, not because they perform better
work, but because their work is less expensive.
Although the general public may yet be unaware of the
reason, the pressure on costs has already caused a shortage of nurses in
hospitals and nursing homes. This affects lives, but no one counts lives, only
money.
The substitution of generic drugs for the originals debases
the currency of therapy to an extent not measured as yet, but certainly the
pharmaceutical companies if financially pressed will cut back on their research
programs so that the current shower of miracles in medical therapeutics will
become a trickle.
The
The public had better get interested in the changing face of
medical practice, examine its subtleties, and learn about its benefits and the
burdens it imposes. Only an informed public can influence the government. To
influence a government one must prod it, irritate it, keep it awake.