The interminable debate over health care reform has understandably focused on the outcomes of patient care: life expectancy, survival rates from various diseases, etc. Frequently, these are discussed in comparative terms--Sweden spends X amount on health care compared to the United States but has a life expectancy nearly three years longer; patients in the U.S. have better five-year survival rates for this type of cancer but not that one. And so on. (Notwithstanding that comparisons of life expectancy across countries can be misleading. The U.S. has a more heterogenous population than other countries, particularly in Scandinavia. And historical inequities have undoubtedly contributed to the continuing disparities we see in the U.S., something no health reform bill will remedy. I also haven't seen much reference to studies showing that pharmaceuticals have added much more to U.S. longevity than actual programs. But the former is attacked while the latter are celebrated.)
Yet what about the process of patient care? Is it important? Should we care about it? I ask because we have a family friend who is now at the beginning of her third pregnancy. She has seen the same OB/GYN for the previous two pregnancies; she also has an endocrinologist who helps manage the pregnancy. She has seen both doctors for five years and has been on the very same medication for all those years. And yet, neither office seems capable of smoothly administering the necessary processes. After labs were drawn at her first OB/GYN visit, the office called the next day with the results yet didn't leave a message. Nor did they call back. Our friend only discovered that they had called, a week later, because she happened to scroll through caller ID. Worse, when she called the office, curious about her lab results, the nurse said, "Oh, yes there is a message here for you: your results are abnormally high."
So that's crazy. Lab results are out of whack and the office tries once, with no message, to contact the patient? This isn't about incompetence on the part of the physician: he knows nothing about the incommunication and if he did, would be quite upset at the lack of proper care for his patient. Once those results had been discovered, moreover, they needed to be relayed to the endocrinologist who prescribes the medicine. But could the OB/GYN do this? Of course not! Because we don't adequately share information across practices! So our friend had to call up the specialist and request a higher dosage herself. Fine: but lo and behold it turns out the the endocrinologist's office can only do that at the request of another physician's office--and they won't send over the delayed lab results! Still worse, the assistant at the second office says it's no big deal to be without the higher dosage (she's pregnant remember) since they can get our friend an appointment next week! How's that for patient care?
Granted, this is only one story from real life. Undoubtedly, plenty of readers have stories of both horror and helpfulness, and we can't really plan a comprehensive reform package based on a series of anecdotes that may not adequately convey the true state of things.
But our friend's dilemma illustrates a larger problem. Yes, we have issues of cost and uninsured and underinsured. But we have this giant administrative labyrinth built into health care that plagues the system and its core, patient care. The provider-patient relationship is often disrupted to the point of inadequacy and perhaps harm. Bureaucracy deadens accountability and our friend's plight perfectly illustrates this. Competition amongst insurers, controlling costs, a public option--these will not cut through the labyrinth. Neither, it seems, would more consumer-empowered care if consumers can't fight through the administrative maze.
So why do we think that the cure for bureaucracy is more bureaucracy? This is a Washington solution, of course: any broken system can simply be repaired by affixing a new system on top of it. Our laws are written by people who have forgotten (or never knew in the first place) what it's like to be without insurance, to be one catastrophe away from financial disaster, or even to have to attempt to navigate bureaucracy in trying to get your necessary medicine or your own lab results. Instead, Senate delegations journey to hospitals to view "mock code" situations and then issue grave statements on the need for such and such reform. This is their insight into health care? Please.