More Myth-Conceptions, and a few Truisms
**There is one standard of care-- Is this even achievable? The three pillars of healthcare, cost, quality, and access must all be in alignment for there to truly be one standard of care. Access problems?? Fixable with more $$. Better quality? You will pay for it, either through reduced access to that gifted surgeon, or through increased cost (or both). Let me illustrate the disparity in care, from my personal situation. As a military member in the state of Alaska I am entitled to care through the military health system. But as you can imagine, we do not have all the services available up here and some of our routine specialty visits are sent to the local facility (yep, singular) or are shipped to Anchorage or elsewhere. Because the local area is Diagnostic Related Group (DRG) exempt providers can and do charge a premium for their services. Our reimbursement rate for care downtown is fixed, yet set lower than Medicaid for Alaska is because it is based on a national formula. Here is the result: an alcoholic on the street has a better chance of being seen than a service member!
**Universal healthcare is free-- Two words: cost shifting. Also, how much is your time worth to you? Or the freedom to chose which provider takes care of you? Do you value second and third opinions? Would you prefer generic or name brand medications?
**Incremental change is the only way to fix the system-- Two words: cost shifting (got to use that one twice!). If incremental change is effective, why the need for HIPAA if you had ERISA + COBRA + FOIA + Privacy Act regulations already in place? Why did managed care fail to prevent the rise in healthcare costs in the U.S.? You must change the provider mix (specialty v. primary/preventive care), the academic system, reimbursement system/formulas, insurance, and even the orientation of the industry (from a treatment to preventive perspective) before you will see lasting change.
Truisms
**If you build it they will come-- When the movie Jaws came out my cousin didn't want to go swimming ever again. How did my aunt fix the fear of swimming? By using an 'arm band deployed, shark scent activated' device...yep, a piece of twine loosely tied to his wrist. That thing always worked and she should have patented it because I NEVER saw any sharks in the city pool. The problem with justifying some sub-specialities (e.g., plastic surgery, urology) is that bean counters want to prove to you that there isn't a need. Of course not! The service doesn't exist in your facility and no patient will knowingly want that service if it means they must get referred elsewhere. If they are referred elsewhere then they do not count in your productivity roll ups.
There are some exciting things in store for the healthcare industry. Glad to be here for the ride...
1:51:01 AM 
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