From my perspective as a patient, a family member of several patients, and as a practicing physician in emergency medicine for nearly twenty-five years, the following:
1) the idea that litigation against physicians or hospitals is responsible for excess medical care costs is not true. I agree that we physicians order a lot of tests and do a lot of things in an effort to avoid getting sued, but the most reliable figures I have been able to find show that the overall cost of med mal litigation, the things we do to try to avoid it, etc, are very small- one percent or less of the medical care spending in the USA. What frivolous suits waste is time more than money- but as someone who's done this for years and fifty thousand hours or more, I can tell you that there is quite a bit of bad medicine out there. And of course there are a lot of bad outcomes, too, but not every bad outcome is evidence of medical negligence.
2) From a purely financial perspective, it is cheaper over the long haul to regulate medical spending by insuring everyone than by having a large group of uninsured patients who we all subsidize. I see the evidence of this every day in the ED. You'll have to trust me on this one, but I firmly believe that it will serve all of us (not just the uninsured etc) better if we bite the bullet, insure everyone, and then have some leverage with which to regulate medical expenses. This is independent of politics or party persuasion. If you have one-sixth of the population uninsured and without resources, AND you have a situation where ERs are obligated to treat everyone and can
t turn anyone away, AND you have a mechanism whereby providers can refuse to treat patients in a non-emergency situation, you end up funneling everyone into the emergency care part of the system, with the kinds of predictable results that we've all seen- dismal ones.
3) Al points out that that marginal or doubtfully qualified people get into medical school. I'd differ with that. The number of people applying to medical schools is so much larger than the number accepted that at least academically, the people graduating are qualified. Whether or not they will make compassionate and effective physicians is something altogether different- but they are at least intellectually qualified. Frankly, being smart is not the essential element here- while you have to be intelligent to be a doctor, you don't have to be brilliant. What IS essential is that a good doctor is thorough, and compassionate- empathetic might be a better term- and those qualities are rather difficult to screen for or test for when determining who gets into medical school.
4) You'd be surprised at how many physicians support universal medical insurance. I do. And while my politics are somewhat liberal, they are not radical at all. As a physician, I see my job as taking care of everyone who needs it, whether or not they are able to pay. I don't think medical care should be reserved for the employed, or the young, or the old, or the wealthy. After all, we're all going to get sick and die someday; it's built in. We might as well face reality and make the best arrangements in advance that we can, shouldn't we? Such arrangements involve facing up to the idea that it's going to happen to all of us.
5) Most of the uninsured people I see in ERs are working. They are not unemployed, they are not parasites, and they are not typically people who abuse their own health. They just don't have any medical insurance.
6) One of the things that drives excess health care spending is physician greed. This is clearly documented and unfortunately quite true. Allowing the fox to guard the henhouse usually results in fat foxes and fewer hens. Our situation with respect to allowing physicians to order procedures and tests from which they handsomely profit is unfortunately no different. It's something we badly need to fix.
