Tel-A-Vision for the 21st Century
Correspondence @ WhiteHouse.gov /RealityCheck
|Links: Day 2, Day 3, Day 4, Day 5, Day 6|
Day 1 Aug 14, 2009
I am a conservative Mennonite, parent of 3, grandmother, former ER nurse and currently a professional midwife. My husband and I are retirement age and both covered by Medicare. After 4 decades of as a professional and a patient advocate in the HC field, its obvious to me that America can’t afford not to reform the way we provide and pay for healthcare. In order to fix the long-term deficient, we must fix health care. For American business to successfully compete in the global economy, we must fix health care. In order to live with our conscience, we must fix health care.
Politically, we must guard against making the perfect the enemy of the good. These problems have been building for decades so there is no instant answer. Like turning like an ocean liner at sea around, no single piece of legislation or new national policy can instantly change its direction. Incremental change is not bad and patience is still a virtue.
Having read all 1,100 pages of the House bill HR 3200, I am pleased to report that the Affordable Health Choices Act is a middle-of-the road piece of legislation. It does not get side-tracked by the liberal desire for a single payer plan or the conservative insistence on that only free-market solutions be considered. Instead this politically moderate bill is masterfully designed to produce a healthcare system that our nation can be proud of – one that is fair and affordable, preserves individual choice and reliably delivers healthcare that is as safe and cost-effective as any other industrialized country. While HR 3200 is not perfect, it moves us toward a balance of power between investor-owed for-profit medical facilities, the public and the mediating function of government to address issues over which we, as individuals, have no control.
The goal of health ASSURANCE can be achieved in the next decade without taxing the middle class, rationing medical services for the elderly, limiting the advance of medical science or turning healthcare over to faceless government bureaucrats. Two trillion a year is more than enough money to treat everyone and meet every genuine medical need.
Yankee ingenuity took us all the way to the moon, surely these same talents can upgrade us to a HealthCare_2.0 system. Money being spent unproductively (or unwisely) can be redirected. Forward-thinking reform can introduce science-based change in how health care and medical services are provided and financed, while incorporating the benefits and cost saving of scientific innovation and new technology. DNA-based diagnosis, genomics and the new science of epigenetics will dramatically reduce future health care costs through early detection and improved treatment. Gene-splicing and yet-to-be invented treatments will eliminate many previously fatal or expensive diseases. All it takes is a can-do attitude and the right expenditure of our plentiful resources.
For policy reforms to be accepted by the public, proposals must address the legitimate concerns of each sector of the health care continuum and be equally beneficial to the insured, the uninsured, GenXers and baby-boomers, taxpayers and businessmen alike. Luckily for us, the reforms proposed in HR 3200 put us on a path to a pro-business and pro-innovation HC system that over the next decade will be able to meet the basic needs of all its citizens.
As an upgraded system, HealthCare_2.0 would analyze our vast knowledge of health and disease so that no model of health care, no form of medical treatment or product is identified as a standard of care without having established its safety and comparative effectiveness. Coupled with evidence-based medicine, this permits the most clinically effective methods and ‘best practices’ to be identified. This provides us with a HC system that can reliably use the right science and the right practitioner at the right time and for the right reasons. This is where preventative medicine starts and the routine overuse of drugs and procedures is stopped. State-of-the-art analysis of comparative effectiveness (ACE) gives modern healthcare providers the tools to ‘ace’ the system in every way – truly a win-win solution. When it comes to 21st century health care, ACE should be the foundation for American standard of care.
An affordable system by 2020 requires that we develop (a) a prevention-based model of care, (b) logical and science-based process to establish the effectiveness of different models and methods of care and (c) high quality, broad-based and easily accessed system of primary care as the hub of the healthcare wheel. This is a multi-disciplinary form of primary care that includes non-physician practitioners (nurse practitioners and midwives) and non-allopathic physicians (naturopaths and oriental medicine doctors, etc) in addition to the traditional role of MD general practitioners.
It’s so much cheaper to reduce rates of
obesity through health-related prevention programs than it is to
treat diabetes and patients suffering from end-stage kidney
disease. It’s ever so more humane to prevent hip fractures than to
hospitalize the frail elderly for surgery. The best way to control
the escalating cost of drugs and medical treatment is to use classic
health care methods of prevention coupled with innovative new
technologies to reduce the number of people who have diseases that
require expensive medications and other medical interventions.
HealthCare_2.0 is good for everybody – ordinary people, health care
providers, business and our democratic form of government.
WhiteHouse.gov -- RealityCheck Day 2 Aug 17, 2009
RE: ‘Advance Care Planning Consultation’-- Section 1233 of HR 3200
My husband and I are retirement age and both covered by Medicare. I've been a healthcare professional and patient advocate for 4 decades. I have read all 1,100 pages of the House bill HR 3200.
It is my informed opinion that reforms proposed in HR 3200 put us on the path to a pro-business and pro-innovation HC system while meeting the basic needs of its citizens. As an upgrade, HealthCare_2.0 analyzes our knowledge of health and disease so that no model of health care, medical treatment or product is recommend as a standard of care without first evaluating its comparative effectiveness. Identifying the most effective methods and ‘best practices’ is where preventative medicine starts and the routine overuse of drugs and procedures is stopped by reliably using the right practitioner and the right science at the right time and for the right reasons.
‘Advance Care Planning Consultation’-- Section 1233 of HR 3200
There is absolutely nothing sinister in sec 1233 -- no death panel for handicapped children, no scheme to save Medicare money by paying healthcare professionals to hand out hemlock to octogenarians. Not a single word in sec. 1233 (or anywhere else in the House bill 3200) even hints at a government-sponsored plan to kill off old people, manipulate medical care providers or force doctors to rat to the government about end-of-life decisions made by Medicare patients. Government-sanctioned euthanasia would be a crime according to state, federal and international law. No American of whatever political persuasion, would allow that to happen.
The only thing being tracked by sec 1233 is the level of compliance by health care professionals in providing information & following the patient’s advance care directives. How these qualities are to be measured and tracked are not mandated by HR3200 or dreamed up by government bureaucrats - they originate with a “consensus-based organization” and are to be published in the Federal Register and to provide for a period of public comment on before being adopted.
The reporting provision of Sec 1233 is actually is a minor amendment of the current Social Security Act’s sec 1861 on advanced directives. This new provision expands the present requirement that hospitals ask patients if they have an advanced directive by requiring practitioners to offer information to patients in a formal ‘consultation’ without pushing any predetermined agenda. This ethical process includes talking about the practical aspects of care and information (legal and otherwise) that help people develop an end-of-life plan consistent with personal goals and their family’s desires.
Sec 1233 identifies the very broadest range of option, stating that: “level of treatment … may range from an indication for full treatment to an indication to limit some or all or specified interventions.” It includes training for health care professionals “about the goals and use of orders for life sustaining treatment”. Physicians, physician assistants and nurse practitioners would simply be responsible for reporting on how well the health care profession provides this information and complies with the patient’s wishes as expressed in the Advanced Care Plan.
Like any other American I would be personally offended by the slightest whiff of duplicity in HR 3200. Government-sanctioned euthanasia would be a crime according to state, federal and international law – a situation totally unacceptable to each and every American, no matter what our personal political affiliation. This is not what Sec 1233 says or does. To put these rumors out of their misery, I created a plan language version of sec 1233 that can be accessed on the home page of www.HealthCare2point0.com. Freed from distracting details and legalese, it’s easy enough to understand and to be sure that is both an ethical and effective contribution to the Social Security Medicare act.
WhiteHouse.gov @ RealityCheck Day 3 Aug 18, 2009
RE: Public Option Controversy; 2-part forward-facing vision coupled with a 3-step practical plan
No matter who pays the bill, there is no way to afford our current dysfunctional system. Media coverage of HC reform rarely identifies the specific principles or practical methods needed to develop a fair system without taxing the middle class, rationing medical services or adding billions and billions to the national debt.
So far, the message from the pro-reform side comes across as ‘pie-in-the-sky'. This position is long on hope but short on specific principles and practical steps. This is regrettable since HR 3200 plugs up many of the places where we are currently hemorrhaging red ink and failing our citizens. Bit as good as HR3200 is, it doesn’t communicate a grand vision coupled with a practical plan.
A safe and cost-effective system must be grounded in a forward-facing vision, because how things are now is not how they will be in 10 years. Second Generation medicine is already on the horizon and moving toward us with great speed. The marriage between the biological, genetic and technological science is revolutionizing 21st century health care in the same way that Pasteur’s 1881 germ theory of infectious disease, coupled with the new science of microbiology and discovery of antibiotics, gave us 20th century "modern medicine". Just as 20th century science provided the principles of ‘sterility’ that make organ transplants and other surgeries possible, so will biological, genetic and technological innovations make surgical solutions unnecessary for an increasing number of people over the next 2 decades.
The other pillar of a forward-looking vision is to acknowledge the distinction between health care and medical care and capitalize on the difference. Health care is a prevention-based model while medical care is a system for after-the-fact intervention. In the US, we do not teach or pay MDs to provide ‘health’ care. An affordable system starts by developing a health-based model designed to promote wellness, improve health outcomes and lower costs by preventing the incidence of disease, reducing the impact of chronic disease and by extending the healthy lifespan. The most direct way to control the cost of drugs is to reduce the number of people who have diseases that require expensive medication. It’s much cheaper to reduce rates of obesity through outreach programs than it is to treat diabetics suffering from end-stage kidney disease. It’s more humane to prevent hip fractures than hospitalize the frail elderly.
Analyzing Comparative Effectiveness (ACE): The first practical step to affordable health care is a rational and scientific process to evaluate the clinical effectiveness of all health models and methods and forms of medical treatments. When combined with current evidence-based medicine, ACE can give us a standard of care drawn from “best practices”, which is a safer and more cost-effective way to provide care. In 2007 Price-Waterhouse-Coopers estimated that $1.2 trillion dollars of the $2.2 trillion spent on US health care was wasted – 55 cents of every dollar. For example, diabetes and its complications is the single biggest item in the healthcare budget, but only 8% of current treatments of diabetes consist of evidence-based ‘best practices’. Since 1/3 of every HC dollar goes to the tx of diabetes, we could save ½ a TRILLION dollars every year by using ‘best practices’. This would reduce the number of people developing diabetics and prevent complications of the disease such as amputations, end-stage kidney disease and blindness. Just by fixing this one problem the proposed HC reforms would pay for themselves several times over. Why aren’t we talking about this?
The other practical step is to develop a high quality system of primary care as the hub of the healthcare wheel. This is the only prevention-focused, cost-effective way to provide fair and affordable HC. Last year there were 902 million doctor’s office visits. Approximately 90% or 811 million of those medical appointments were for self-limiting conditions and other types of non-urgent or preventive care.
Self-limiting conditions includes mild illnesses, minor injuries and other conditions that resolve spontaneously without drugs or medical procedures. Everyday care includes routine checkups, health education, monitoring normal biological states (pregnancy, healthy newborns, well-woman gyn), prescription refills, concerns about normal aging and support for people with stable or chronic diseases. Most primary care visits are for problems that don’t need or benefit from medical intervention, which results in an unfortunate mismatch of resources. For the last century our medicalized model of health care has been spending the incredibly expensive time of MDs to provide routine primary care that actually does not require the education of an MD to accomplish safely and efficiently.
The best foundation for a high-quality system is a multi-disciplinary form of primary care that includes non-physician practitioners (nurse practitioners, midwives, PAs) and non-allopathic physicians (naturopath, oriental medicine doctors, etc) in addition to the traditional role of MD general practitioners. The idea of the right practitioner for the right problem saves the health care system vast sums of money that can be redirected to improved health care coverage.
Board-based primary care, in conjunction with ACE-determined ‘best practices’ as the standard of care, can save enough money to eliminate the need to ever choose between rationing medical care and escalating the national debt. This combination of forward-facing vision, a can-do attitude, the use of best practices and a high quality primary care as the hub of the healthcare wheel is the HC upgrade that can keep us competitive in the global economy and safe at home.
WhiteHouse.gov @ Reality Check Reality Check -- Day 4 Aug 19, 2009
RE: A health-based versus medically-based system:
We must take the important difference between health-based care and medical services into account when talking and thinking about reforming health care. At a policy level, we have to acknowledge the distinction between health care and medical care and capitalize on the difference. Health care is a prevention-based model while medical care is a system for after-the-fact intervention. What we have now is basically a medical system developed to intervene in the course of an already established disease or after a preventable injury has occurred (cancer, diabetes, drunk-driving accidents). Only after a patient’s health has seriously deteriorated or a medical crisis occurs does this system of medical intervention come into its own, which then involves the use of expensive drugs, invasive medical treatments and heroic surgery. While modern medicine offers early detection through testing for diabetes or other chronic diseases and prescribing cholesterol-lowering drugs, the medical training of MDs and reimbursement for their professional services are neither one organized around the preservation of health or prevention of disease. In the US, we do not teach or pay MDs to provide ‘health’ care.
The focus of a health-based model is to preserve, protect and maintain the health of the already healthy (over 90% of the population). Health-based care includes scientific research, public education and patient services designed to prevent suffering and prolong healthy function during the normal human lifespan by reducing the frequency, duration and severity of disease (including alcoholism). The best way to control the cost of drugs is to reduce the number of people who have diseases that require expensive prescription medications. It’s so much cheaper to reduce rates of obesity through health-related outreach programs than it is to treat diabetics suffering from end-stage kidney disease. It’s more humane to prevent hip fractures than to hospitalize the frail elderly and do surgery. In our national search for effective and affordable care, we must develop policies that see a health-based model as the bedrock of the system. A health-based system appreciates medical services, but is organized around the preservation of health and the prevention of disease.
When crisis-intervention medicine is compared to the top 5 causes of mortality, it is easy to see the unproductive expense and other problems caused by not having a health-based model of care. When ranked by category, the five most frequent causes of death in the US are all preventable diseases or avoidable accidents associated with 1) smoking (lung cancer & heart disease), 2) alcoholism (liver disease and fatal car accidents), 3) complications of obesity (diabetes, kidney disease), 4) drug abuse (overdose, crime-related murders) and 5) exposure to toxic substances and poisons, including air and water pollution (fatal asthma attack and death from acute toxicity). [Dr G, Medical Examiner, 2008]
One measure of the medical costs of untreated
mental illness comes from a study of 120 homeless alcoholics living
on the streets of Boston who collectively chalked up a staggering
18,000 EMS calls-ER visits and 900 hospital admissions over five
years – 150 per alcoholic. Costs to the county for emergency medical
services were estimated at $26,000 each year for each alcoholic, but
until such a time as these alcoholics get liver disease or hit by a
car, that $26K worth of repeat ER visits did nothing to successful
treatment of their basic mental health problems, but it did add over
$3 million to the ‘health’ care bill sent to the taxpayers of
Massachusetts or $15 million over the course of the study.
[NPR story 08-04-09] When it
comes to our health and our pocket book, an ounce of prevention is
still worth a point of cure.
WhiteHouse.gov @ RealityCheck Day 5 Aug 20 2009
comparative effectiveness (ACE)
A health-based model of care uses a process of scientific evaluation to analyze all models and methods of care, medical technologies, treatments, devices and products for their comparative effectiveness, that is, a combination of clinical success and cost-effectiveness. Analyzing comparative effectiveness (ACE) applies to the big picture -- models and methods of care, as well as medical products and devices. ACE compares different types of care against one other and the baseline of no intervention or treatment.
This differs from evidence-based medicine in the same way that the forest is different from a single one tree. Most evidence-based medical research makes comparisons between prescription drugs and customary allopathic treatments such as surgery versus conventional medical management. These studies typically compare two different types or doses of the same drug or two different cholesterol-lowering medications against each other to determine which of the two options is safer or more effective. This does not include cost, does not establish the drug or medical therapy as effective in relationship to other methods of management, such as diet and life-style changes, and it doesn't take the unique aspect of individual patients, such as ethnicity or cultural traditions, into account.
When information from the analysis of comparative effectiveness is combined with evidence-based medicine and the clinical judgment of experienced practitioners, it provides the elements necessary to determination clinical effectiveness and makes possible a health care system based on ‘best practices’. Currently only about 20 to 30% of healthcare methods and customary medical treatments have a proven track record for safety, clinical effectiveness and a positive cost-benefit ratio.
For instance, diabetes and its complications is the single biggest item in the healthcare budget. One third of every healthcare dollar is spent on diabetes, but only 8% of current care for this disease is based on scientifically established ‘best practices’. As a result, complications of diabetes are the leading cause of all blindness, amputation and kidney disease in the US. Data on kidney dialysis from Medicare shows that annual patient cost ranges from $65,496 to $488,360, for an average of $129,090 per year for each patient.
In addition to the direct expense of ineffective treatments, the lack of a system of ‘best practices’ as the foundation for our healthcare allows the defensive practice of medicine to flourish. This describes decisions made for legal reasons based on what is ‘customarily done’ (at most 30% effective), instead of what is best as determined by a consensus of scientific criteria. This unnecessarily subjects a large percentage of the ill and the elderly, as well as childbearing women and newborn infants, to expensive, painful, invasive and potentially dangerous procedures. Specifically in relationship to childbirth, the result of the defensive practice of obstetrics is a 35% episiotomy rate, 32% Cesarean section rate, a 23% rate for induction of labor and efforts by the profession to make Cesarean delivery the new standard of care. If our national policy required comparative effectiveness to be established before a model of care, a method of management, a medical treatment, devise or product was identified as the standard of care, the defensive use of tests and medical treatments, as well as interventions that simply reflect professional preference of the physician or obstetrician, would be replaced by “best practices”.
The only way our healthcare system can be built on “best practices” is by scientifically analyzing all health care models, methods and products for effectiveness and ranking each one in comparison to other models or modes of treatment for the same mental or physical condition. For example, the Veterans Administration’s clinical policy is to only use ‘best practices’ -- models of care proven effective based on their own internal review of treatment outcomes. Using 294 measures of effectiveness and patient satisfaction, the VA is rated by researchers as far above that of every other healthcare system, including private facilities with a world-class reputation.
Even more amazing, the VA’s healthcare system has the lowest per patient cost of care – one-third less than Medicare, which is already a third less expensive than care in private institutions. The VA is successfully treating people for 2/3s less than any other segment of the health care system and getting rave reviews from its patent based. If the scientific principles of comparative effectiveness already being used by the VA were widely applied to the treatment of diabetes, it would reduce the complications of diabetes by 80%. That’s a ten-fold reduction in the horrific, disabling and expensive complications of blindness, amputations and end-stage kidney disease.
In 2007 Price-Waterhouse-Coopers estimated that $1.2 trillion dollars of the $2.2 trillion spent on US health care was wasted – that’s 55 cents of every dollar. If figured as 1/3 of that $2.2 trillion, our inability to apply proven prevention methods and ‘best practices’ to the issue of diabetes costs the US three-quarters of a trillion every year or $7.3 trillion over the next decade. Simply fixing that one problem would make the proposed reform of the HC system pay for itself several times over.
Only comparative effectiveness can re-write
the playbook for the 21st century. It gives us a new
start that allows us to ‘ace’ the system by intelligently
determining what is safe and effective, thus allowing us to spend
our money more wisely. State-of-the-art analysis of comparative
effectiveness (A.C.E.) gives modern healthcare providers the tools
to ‘ace’ the system in every way – truly a win-win solution. When it
comes to 21st century health care, ACE should be the
American standard of care.
WhiteHouse.gov @ Reality Check Day 6 Aug 21, 2009
RE: High quality, broad-based, easy access primary care services:
Clinically effective and affordable health care always starts by systematically improving health outcomes and lower cost by preventing the incidence of disease, reducing the health impact of chronic diseases and by extending the healthy lifespan. High-quality primary care is the only prevention focused, cost-effective system can achieve those goals. The best way to control the cost of drugs is to reduce the number of people who have diseases that require expensive prescription medications. It’s so much cheaper to reduce rates of obesity through health-related outreach programs than it is to treat diabetes or patients suffering from end-stage kidney disease. It’s ever so more humane to prevent hip fractures than to hospitalize the frail elderly for surgery.
Last year there were 3 doctor’s office visits for every American. The vast majority of those 902 million visits were for routine healthcare needs. Approximately 90% or 811 million of those medical appointments were for self-limiting conditions and other types of non-urgent or preventive care. Self-limiting conditions includes mild illnesses, minor injuries and other conditions that heal spontaneously or resolve by themselves without need for drugs or medical procedures. This kind of care consists of routine checkups, health education and information, monitoring normal biological states such as pregnancy, healthy newborns and well-woman gyn visits, refilling prescriptions, concerns associated with normal aging and support for people with stable or chronic diseases.
What people seeking non-urgent health care most want and need is a relationship with an unhurried primary-care practitioner who is able and willing to be empathetically present, to listen, talk, ask questions, sympathize and make helpful suggestions. Primary care practitioners help each person they see stay healthy, become healthy or lessen the impact of a chronic disease. They take the time to educate the patient (or parent/ guardian) in the best strategies for managing their health or that of their child or aging parent. This personalized form of care reduces the need for expensive testing and invasive procedures while improving patient outcomes. Research shows that high-quality primary care is the most effective way to improve outcomes while preventing the systematic overuse of drugs and surgery. [Am College of Physicians - White Pager 2008]
Since the number of primary care visits in the US is expected to increase 42 % by 2025, this kind of relationship-based care is ever more important. The growing US population will include an increased proportion of children, retired baby-boomers and patients with chronic diseases – the very categories of patients that benefit most from the coordination of care and continuity of care provided by primary care practitioners. [Am College of Physicians - White Pager 2008]. Reducing rate of obesity, diabetes, osteoporosis and many other chronic and expensive diseases eliminates the great volume of expensive and invasive procedures currently driving up the cost of health-related services.
At the turn of the 20th century, primary health care was provided by medical doctors, non-physician practitioners (including midwives) and non-allopathic physicians. In 1910 the traditional multidisciplinary pool of practitioners was replaced by an MD-centric system. This means that primary care has essentially been provided by MDs for the last hundred years. However, the interest and enthusiasm of MDs for primary practice has steadily fallen over the last century. While the category of primary care is vital to the health and wealth of the nation, we never have, do not now and never will compensate MDs at a level appropriate to their education and training. As a result, 75% of today’s MDs choose specialty medicine, with fewer than a quarter of new graduates becoming general practitioners. The 25% who start out as GPs quickly discover that a primary care is a system organized around saving the physician’s time. In spite of valiant efforts to see more patients more quickly, poor reimbursement rates and inability to meet office expenses (or pay off $140,000 in student loans) forces a large proportion of GPs to close their doors within a few years and retrain into a better paying specialty.
MDs are specialists trained to diagnosis and handle acute and life-threatening medical emergencies that require pharmaceuticals and surgery. However, most primary care visits are for problems that don’t need or benefit from medical intervention, which results in an unfortunate mismatch of resources. For the last century our medicalized model of health care has been spending the incredibly expensive time of MDs to provide routine primary care that actually does not require the education of an MD to accomplish safely and efficiently. The same 8-12 years of post-secondary training as an MD so crucial to emergency intervention and brain surgery is neither necessary nor cost-effective when providing routine health care.
Research on doctor-patient interaction as it relates to accurate diagnosis shows that the average patient takes approximately 2 minutes to give a full account of his symptoms and yet the average busy MD cuts the patient off after only18 seconds. Doctors often form a diagnosis within 30 seconds and stick to it even if subsequent information doesn't fit. [How Doctor Think by Dr Jerome Grossman] In addition to the patient's frustration, this interrupted communication often results in a diagnostic error that can send the patient on a wild goose chase or includes many unnecessary and expensive tests. "Saving time" result in a failure of communication that often harms patients and put physicians at risk for malpractice suits. From the patient (and taxpayer’s) standpoint, the ‘right use’ of an MD’s time is in places that benefit from their intensive medical training.
The most appropriate and cost-effective choice for primary care are non-physician healthcare professionals -- nurse practitioners, physician assistants, professional midwives, naturopaths, oriental medicine doctors, etc. Each of these practitioners is trained to provide routine and preventive primary care. Ordinary health-related complaints include mild illness or depression; normal biological states, life-style issues (diet, exercise, contraception; questions about sexual topics); students physicals; vaccinations or testing for STDs; managing a stable chronic disease, and more. What each of these conditions and health concerns share is that they are not medically complicated. However they are frequently time-consuming and certainly take more than the 6 to 10 minutes typically allotted to the typical non-urgent medical appointment.
The idea of the right practitioner for the right problem saves the health care system vast sums of money that can be redirected to improved health care coverage. Board-based primary care, in conjunction with ACE-determined ‘best practices’ as the standard of care, saves enough money to eliminate any need to ever ration medical care for the elderly, disable or terminally ill. Instead of fighting the escalating rate of MD specialization, primary care and best practices makes it possible to pay for the kind of advanced care that only MD specialists can provide. MDs who are currently providing primary care and want to stay in general practice medicine would become the invaluable hub of a primary care system. While non-physician practitioners (NNP) and non-allopathic physicians would be on the front lines in large numbers, physician GPs are equally vital. They must be able to take referrals whenever a patient’s condition requires allopathic medical services or if the patient prefers to be followed by an MD practitioner. Regardless of the category of caregiver, high quality healthcare always preserves and protects individual choice.
A cost-effective system must rely first and foremost on non-physician, primary care providers. This is made possible by having timely access to medical doctors, hospitals, and surgery to be used in event of a serious or urgent medical situation. Fortunately the U.S. has created an excellent system of emergency, “at-the-scene” care, stabilization and transport, via first responders, ambulance and fire department teams and transport by helicopter and plane. This shows that we do know how to create a cooperative and collaborative model for health care for everyone, which is so necessary in creating a system that focuses its resource on prevention! It is also how to stem the overuse of prescription drugs and medical tests and procedures, each of which carries risk of harm to patients, even when they are used appropriately.
A prevention-based model founded on best practices would naturally include high-quality primary care as the center of the healthcare wheel and produce a system that is both healthy and caring and doesn’t break the bank. A new perspective will develop in the social, political and economic realm and we will find ourselves with a health care. This win-win solution is as American as apple pie and best of all, it is good for everybody – ordinary people, health care providers, business and our democratic form of government.
This website is dedicated to Baby Boy Lance Anderson and Donna Driscoll , LM