For-profit Health Care Isn't Working

MAINE VOICES The problem isn't the wealthy or the poor, it's the working families that can't get coverage. CHRISTOPHER T. BARTLETT, Special to the Press Herald June 11, 2008 about the author Dr. Christopher T. Bartlett (DoctorBartlett@mac.com) is a family physician in Portland. As a family practice physician caring for patients here in Maine, I worry that the health-care system itself is in critical condition. One would think that most of my office time and energy would be focused on patients and their medical concerns. In truth, much of the time that my nurse and I spend each day is focused on finances. In the exam room, I have to ask which drug my patient can afford. Has my patient met the deductible? How can we present a case to the insurance company to get the surgical procedure paid for? While most wealthy people and most impoverished people receive good care, a large population in the middle often has to do without any medical care. Many of my patients have worked and gone to school in an effort to get off MaineCare and welfare. When they "succeed" and get an entry-level job, they often find they no longer qualify for MaineCare and now must shoulder the burden of their health-care expenses alone. When low-income patients apply for "free medicines" through drug companies, they often send me their entire application packet, complete with personal financial details. I am uncomfortable seeing their finances laid bare to me. I can look upon naked bodies all day; I am trained for that – but I shudder when a tax form or balance sheet of such intimate, mortifying detail is laid before me. My discomfort with doing more and more accountancy instead of medicine has bothered me for years, but I realized the other day why it bothers me so. I believe that what is wrong with health care today is the profit motive – attracting entrepreneurs at every stage of health-care delivery. I believe that capitalism and free markets have made this country great. Certain essential services, however, require other kinds of solutions. To subject these essential services to market forces could compromise our well-being. Let me give you a few examples where this may be true. If your house is on fire, you call the fire department. Highly trained professional firefighters rush to your house with multimillion-dollar equipment to extinguish your fire. Nobody asks for a co-pay. Nobody asks to see your "fire insurance card," and nobody fills out paperwork for prior authorization. This is a service that we as a society have decided we each need and deserve, and we pay for it through taxes. Police protect us in the same fashion – no charge, no co-pay. Post office? Everyone pays the same rate for a stamp. Roads are built, borders secured, foods inspected, and our armed forces stand at the ready. Why is something as important as medical care treated so differently? Why do so many of our friends and neighbors go without basic health care because they cannot afford it? When you look at the many insurance companies and government programs paying for medical care, imagine how many different people it takes to push around all the different forms, publish all the rule books and pay people from CEOs to secretaries. It's no wonder our system is so expensive and inefficient. As a simple family doctor, I don't have a prescription to fix this problem. I am trained to recognize disease, and our health-care system appears to be gravely ill. We all have a stake in keeping this patient alive. My sense is that removing the duplication of services, high administrative overhead and profit motivation is a good first step. How best to accomplish this is an enormous challenge. I think we need to talk amongst ourselves, talk with our legislators and work for a system that provides a "healthy" health care system. Copyright © 2008 Blethen Maine Newspapers