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Monday, October 20, 2003Americans express broad, and in some cases growing, discontent with the U.S. health care system, based on its costs, structure and direction alike — fueling cautious support for a government-run, taxpayer-funded universal health system modeled on Medicare. In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system. That support, however, is conditional: It falls to fewer than four in 10 if it means a limited choice of doctors, or waiting lists for non-emergency treatments. Support for change is based largely on unease with the current system's costs. Seventy-eight percent are dissatisfied with the cost of the nation's health care system, including 54 percent "very" dissatisfied. We should be careful what we ask for, we just might get it, and then make no mistake, there would be limited access to doctors and waiting lists for treatments. That's the way monopolized payers ration care. The most frustrating aspect about this debate is that it's always presented as only two options - our current system or a single-payer system. There's never any mention of revamping the current system so that it's no longer linked to employment, or of taking the third payer out of basic care and limiting insurance to catastrophic coverage. Quite truthfully it's in basic care that our spending, especially on drugs, spirals out of control. I've often sat with patients who complain that they're taking too many drugs and try to weed out those that aren't truly necessary. "That Aricept that you take to help your memory? It's giving you a few percentage points in memory retention. Probably not enough to notice the difference if you stop." "Oh, no. I need that. I don't want my early Alzheimer's to accelerate." "Well, that Lipitor is only improving your chances of avoiding a heart attack by a few percentage points." "Oh, no. Can't risk not taking that." "OK. You could do without this Zoloft. You started taking it when your husband died last year, and you seem to have adjusted well." "Oh, no. Since I started it, I don't snap at my family nearly as much. Can't stop that." The bottom line is that few people have to pocket the expense of these drugs that are either marginally beneficial or that they're taking for marginal reasons, so they have no incentive to consider their shortcomings or limited benefits. And even those who do pay for them have trouble understanding their marginal usefulness. They've heard so many good things about them in the media and in the direct to consumer advertisements, that it's extremely difficult to overcome the mindset that they're more effective than they are. The medical profession deserves the largest share of blame for this. We too eagerly embrace the latest research findings and media hype without questioning its validity or clinical usefulness. We've shamelessly promoted drugs as the solution to everything. And now it looks like we'll soon reap the bitter fruits of our thoughtless enthusiasm. posted by Sydney on 10/20/2003 07:58:00 AM 0 comments 0 Comments: |
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