Today, I do her pap smear, and get her a mammogram. Another day we work through her insomnia. Yet another day we figure out how to fix a knee that hurts.
I sell primary care. I’m proud of my work – it’s the only medical service that improves life expectancy, that reduces the cancer death rate, the heart disease death rate, and increases life expectancy. It’s the only medical service that meets people where they are, as they are, and tries to listen.
I don’t sell health insurance. Health insurance costs between $500 and $1000 per person per year for the paperwork alone. Primary care, on the other hand, costs $150 per person per year.
Our political candidates believe that we can create access to health care for all Americans by working with, or remodeling, our health insurance marketplace. But 60 years of health insurance, uncontrollable costs, expenditures that now comprise almost 17 percent of the Gross Domestic Product – more by far than any country in the industrialized world– 47 million uninsured, and population health indicators that leave us ranked between 25th and 75th in the world, all suggest that our problem is not in fixing insurance; indeed, our problem may be with our failed attempt build an insurance system before we built a health care system.
Every country in the world that is effective at controlling costs and improving the health of populations achieves this result by providing primary care to everyone in the population. Primary care is affordable and incredibly effective. It’s also a stable, predictable cost, with reliable and meaningful outcomes.
We spend about $700 billion a year on Medicare and Medicaid. If we could save 30 percent of that, we’d save $210 billion. A robust primary care system costs $120 billion a years, and servers everyone in the US, not just people with Medicare and Medicaid.
We can provide a primary for all Americans with little addition investment. If we do so, we will decrease the cost of health care by 30 to 40 percent, and improve the measured health of all of us.
Instead of arguing over an irretrievably broken insurance system, let’s give primary care to everyone. Instead of arguing one payer or many payers or health savings accounts, lets agree to provide all Americans what we know works.
Our presidential candidates should be telling the American people that we can improve the health of all Americans, reduce our costs, and care for the uninsured, just by giving all Americans primary care.
And then we’d have a health care system.
If not now, when?
Michael Fine, MD
Physician-in-Chief, Dept. of Family and Community Medicine, Rhode Island Hospital
Co-Author of “The Nature of Health”
Dr. Fine – a good serious analysis, but have you heard this one?
A guy goes to heaven.
God says that he can ask 3 questions. So the guy asks, will there ever be world peace? God says, “in 6000 years men will realize that peace is better than war and put down their arms.” The guy asks, will men and women will ever get along, and God says, “in a million years, men and women will evolve to the point where there will be true joy between them.” For the final question, the guy asks, “Will we ever have a health care system that makes sense?” God thinks for a while, then says, “Yes, but not in my lifetime.”
Happy Mother’s Day to all the Moms out there. I saw this excellent post while logging on to send out a few photos of my two boys–the grandkids–to my Mom for Mother’s Day.
Michael Fine has given us a convincing post about the central role of primary care in an effective health care system and I thank him for his efforts, both in writing this and in his work as a primary care doc.
In addition to universal primary care we also need–and must demand nothing less–than a program to guarantee comprehensive care for all, such as the reforms in HR 676 (see http://www.healthcare-now.org ). HR 676 will create a complete health care system in the U.S. modeled on Medicare-for-All that is much more cost effective, more clinically effective, and light-years more humane and civilized.
Everybody In, Nobody Out, comprehensive care for all is the only sensible and civilized way to do it, so that if the mammogram Dr. Fine orders for his patient shows a mass that turns out to be cancer, his patient will not be without access to tertiary care (acute care) and so she will not have to start holding bakesales or max out her credit cards to pay for her cancer treatment or worse, ie impoverish herself to become “eligible” for needed care, or die from a treatable illness due to inadequate “coverage”.
The profit-driven insurance and drug companies are killing many of us–20,000 a year per the non-partisan Inst. of Medicine–and maiming many more while getting away with the biggest rip-off ever seen in this country; the money that Americans pay to this industry is way more than to the Iraq war–just add up the insurance co. and drug co. profits year after year. It’s obscene.
“Joke” makes a sobering point about the fight we’re in the midst of to reclaim our healthcare system for ordinary people’s needs rather than for corporate and individual fortune-making. But it IS a winnable fight. Every other corporate democracy has such a system and each spends far less and gets far better health outcomes from it. Americans are increasingly demanding an overhaul of our broken system so that it is funded fairly and will guarantee care for all (not to be mixed up with passing a law that forces everyone to purchase expensive private insurance of questionable valuable, ie “The MA Plan”).
Improved American Medicare-for-All is an excellent model that hundreds of thousands of activists, including many elected officials, are already working toward; in MA 7 of our 10 congressional reps. have endorsed HR 676 and citizens have held 3 statewide events to educate others. Primary care is essential and it needs to be the central component of cost-effective, clinically effective, comprehensive quality healthcare for all. PBS did an excellent program on this May 9, 2008 “Nurses: Standing Tough on Health Care” that shows one reason why this fight IS winnable in our lifetime http://www.pbs.org/moyers/journal/05092008/profile.html
I urge all who must be convinced of the pressing need for our state and country to eschew the current health care “non-system” to view this important talk by Dr. Michael Fine.
http://media.bryant.edu/Mediasite/Viewer/Viewers/ViewerVideoOnly.aspx?mode=Default&peid=7705278a-cd9f-45d1-b696-37de8b309e70&pid=ac7bc554-8ed6-4326-9d73- ba8a65a473b6&playerType=WM7#
“The Nature of Health”
Presenter(s):Michael Fine
Date:2/25/2008
Time:3:00 PM EST
Length:1 Hour 27 Minutes 23 Seconds
Description:What Has Gone with Our Healthcare System and How We Can Fix It
As a “consumer” of health care, a disabled mother who uses Medicare and Medicaid, I started reading this discussion because “CommonHealth” is the name of a MassHealth program for working disabled people which has been my coverage from time to time. I applaud the efforts of Michael Fine and Ann Malone. In my opinion, health care (health care, not health insurance) is right up there with life, liberty and the pursuit of happiness. I have an MA, and I can barely figure out who is supposed to pay for what! Thank you all for your work!
Doctor Fine and Ann Malone RN know first hand the problems in our medical system and know how to fix the problems why are there so few of the medical professionals speaking out?If all of them got together throughout the Country there could be a real health reform for all of us.The Nation could benefit now and so would future generations how awesome that would be.Thank You Dr.Fine and Ann MaloneRN for your service and your concern for this important issue.
Thanks so much Dr. Fine, Beth, Ann and Norma, et al.
It never ceases to amaze me on a daily basis that our state reps and senators were willing to pass such a wasteful, harmful and punitive law and had the audacity to call it health care reform.
This non-reform is hurting far too many residents with regard to their financial stability, medical care and stress levels, yet these same reps and senators continue on their merry way ignoring the concerns and pleas of their constituents. The canned response is: It’s not perfect but we’re working on it.” To me, this means they were (and are) willing to play with lives, and it makes no never mind to any of them if people are being hurt while they experiment. I never gave them my permission to experiment on me.
When a bicycle manufacturer hires a designer to come up with a child’s bike, and the design is manufactured and mass marketed, although both the designer and manufacturer know that one of the wheels is going to fall off, this constitutes a lack of due diligence. Our MA legislature did not practice due diligence in the case of Ch. 58 and, in fact, could be accused of depraved indifference if they didn’t have immunity.
Today, and not for the first time, my state senator’s health care aide told me that MA will continue to implement this health care reform, it’s here to stay, and, in fact, they are working on Step 2 (S2526) which will address transparency of cost, gift bans, offering incentive to attract nurses and/or doctors to MA and one or two other items. (I don’t have it in front of me at this moment.)
So I guess the MA senate thinks we can tell the food market owner and heating oil man – hey, we’re waiting for S2526 to kick in so we’ll pay ya later OR gee whiz, what am I gonna do? I have a medical crisis and can’t find a doctor who will take Commonwealth Care patients. Guess I’ll have to wait and see if S2526 attracts any medical people to MA.
S2526 doesn’t begin to offer the immediate and necessary relief residents require and is merely political pandering in an effort to prop up a failing policy and keep up the charade of “success.”
Too many residents couldn’t afford the plans at the 2007 prices, much less the 2008 increases that kick in on July 1, particularly those for Commonwealth Care (300% FPL and below) which include doubling the copays which discourages care, thus, saving the state money. And many cannot afford to upgrade their coverage during 2008 to meet the state’s requirements under this law.
When do our elected state officials get real and realize that this MA freak show is hurting a lot of hard-working taxpayers and it’s going to get worse as living costs continue to skyrocket weekly while incomes remain stagnant? It’s also doing a heck of a job on the state’s coffers which were on shaky ground before this bloodsucker came along.
Deval Patrick could have done something to alleviate the stress, waste and hurt this law has and is causing by dropping the mandate, changing it to $1 per year or postponing it for 10 years, just to name a few ideas. But he considers it a success although he admits that it’s not good if it’s hurting people. (Cliff notes version but he DID say this on the March 13 NPR statewide call-in.) Alas, his political ambitions seem to be more important to him than the residents and small businesses in MA.
We deserve and have the right to quality, affordable, equitable health CARE, not a health INSURANCE mandate that was designed for the profits of the industry and not for the well-being of the people.
A group of dedicated professionals and grassroots MA residents have joined together with doctors, health care professionals and other citizens across this nation to educate Americans about the harmful effects and wastefulness of the individual health insurance mandate. Thus far, our efforts have borne fruit and, soon, as a nation, we will come together to stop such an assault on hard-working taxpayers here in MA and throughout this country.
In the meantime, please check out HR676, the viable solution to this country’s health care crisis:
http://www.phimg.org or http://www.healthcare-now.org
And to the MA powerbrokers, insurance companies and legislators: Our health is not your wealth.
[...] system doesn’t work. Many others have expressed similar sentiments. Dr. Michael Fine’s posting in this space argues for building a health care system based on primary care. “Primary care [...]