 Saving Marguerite
Ryan: Solutions
By CHARLES C. RYAN
Marguerite Ryan deserved a better deal than she has received from the
American health care system.
If that doesn't matter to you, it's only because what happened to her
hasn't happened to you, or one of your loved ones yet. But it will. The
odds are against you.
Over the past week I've cited a number of flaws in the system. They
stem primarily from the fact that the system was designed by bureaucrats
more interested in streamlining, fraud prevention, and cost accounting
than in providing actual health care.
They have created a bureaucracy under which it costs three or more times
what it ought to cost to care for patients even on something as simple
as direct nursing.
Why?
Because your government doesn't trust you.
Most people don't trust government, but few realize that the reverse
is also true. Government doesn't trust you. It doesn't trust you to file
your taxes honestly. It doesn't trust you to handle your own health care
needs. It is more concerned about health-care fraud than it is about providing
actual health care. That's what all the regulations are for. Not to provide
health care, but to prevent fraud.
It is much easier to prevent fraud if the bureaucracy is eliminated,
as bureaucracies cannot react fast enough to detect or stop fraud. Individuals,
however, can. If a 10-percent fraud detection reward were provided individuals
who reported instances of Medicare and Medicaid fraud, fraud would stop
quickly.
It is very easy to criticize flaws in a system. It's much tougher to
suggest improvements:
Here are a few I can suggest:
Drop the bureaucracy. Issue qualified patients identity cards with
which they can select the care they need, subject to approval by their
physician (the government doesn't trust physicians, either). Such a computerized
card system would eliminate 85 percent of the current paperwork and bureaucracy.
In the case of my mother, she could have contracted directly with Clark
Care for nursing services and those services would have cost the government
one-third of what it was paying to a Medicare-approved agency.
Get away from designing massive categories of care. People aren't
square pegs to be fit into square holes. As well-meaning as many of the
existing programs are, they cannot cope with all illnesses. And as long
as there are large categories, illnesses not included in those categories
go untreated because the bureaucracies cannot relate to anything as small
as an individual, or an individual's needs. Trading the bureaucracy for
a direct billing system will save billions.
Trust the people. Maybe, in turn, they'll start to trust government.
Require health care professionals to listen to their patients. On
numerous occasions during my mother's long illness, "experts"
or "professionals" have insisted there was only one way of doing
things. Respiratory doctors have changed her trach, even though they were
told by family members that she had a special trach, longer than a regular
trach. When the regular trach was put in, the stenosis closed her throat
and she couldn't breathe. This happened several times and was an unnecessary
ordeal for her.
Keep the primary care physician in charge. Prohibit other physicians
from performing unnecessary tests -- particularly those which have already
been performed -- or changing medications. Prohibit nurses in hospitals
or nursing homes from changing medication without the approval of the primary
care physician.
Currently nursing homes let their own physician on call request tests
and change medications at will. Far too often the medications are used
to "calm" patients, rather than actually treat them for an illness.
Almost every time my mother was sent to a new facility, the staff of
that facility seemed determined to re-invent the wheel, to perform tests
which had already been done, to tinker with medications. All to the patient's
detriment and adding to the cost of health care.
Create a federal bureau of health care explanations. It is nearly
impossible for an ordinary citizen to determine what care he or she is
eligible for, where to obtain it, and how to change it. We were given the
wrong information two or three times more than we were given the correct
information, and this was by the experts and professionals in the health
care field.
Establish a clear appeal process for treatments for all patients.
It was impossible, using ordinary means, to find anyone in charge of Medicare.
It was impossible to get anyone to return phone calls about possible appeals.
Buck-passing occurred in an infinite loop that went nowhere.
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