Health Care Reform: Our responsibility… could we do it without government intervention?

The U.S. health care system is the most expensive in the world (Univ. of Maine, 2001). Interestingly about 20% of that cost is due to administrative expense. For example,  your health care provider’s office would be much less expensive if they did not have to hire extra people to help with coding, billing, and insurance claims. Likewise, the expense of health care education, malpractice claims, and staggering pharmaceutical charges are also driving the system costs up. The bottom line: There are millions of Americans without insurance, the system is too complex for even its own employees to navigate, and even for the insured access to care is limited.  We all know something has to be done, the question is… how can we fix it?

I appreciate that the answer is complex and that it requires much thought, but there are so many people afraid of government intervention and the complexities that will accompany it, look how simple they keep the federal tax code, that I am wondering if there are some changes that could be made to the system to cover those uninsured while keeping the government out?… IF there are not MAJOR changes then the government needs to step in and fix things, but how long should we wait to see if the private sector will make any changes? Here are a few facts about the current INSURANCE driven system:

• Even with 46 million uninsured, we still spend more than any nation on health care. (National Coalition on Health Care, 2009).
• The annual premium a health insurer charges an employer for a  family of four averaged $12,700, 2008 (National Coalition on Health Care, 2009).
• The U.S. is the onlyindustrialized country in the world that does not provide access to care for all of its citizens, besides South Africa (Maine, 2001).
• The U.S. infant mortality is 26th out of industrialized nations in the world (Main, 2001).
• Under the WHO category “Fairness in Financing” the U.S. was lowest of all industrialized nations in the 2000 WHO evaluation of health care systems. (Maine, 2001)

Some Things That are Right

Some things have changed for the better in the last several years, improving cost and access. Although there are some professional organizations that do not like these changes, they are increasing affordability and access to those without and therefore cannot be ignored.

• The Walmart 4$ list (forced many retail pharmacy chains to also develop a low cost drug list). Although the lists are not complete for treating all major illnesses, they are a good starting point for many patients. http://www.walmart.com/4prescriptions
• Medical Walk-in clinics in retail stores. I can hear the critics already…. saying a medical home is best and ‘doc-in-the-box’ is bad. I agree, but the reality is that many people can afford to pay lower out-of-pocket costs to be seen in these types of clinics, that they decrease Urgent Care and ER over crowding, they are available when other offices are not, and they offer at least SOME place that those without insurance can be seen without an outrageous bill.
• NP owned and run clinics. Although there is much regulation in many states (that I feel should be reconsidered…. see my post on nurse changes to health care reform http://nursestory.wordpress.com/2009/06/11/considering-nursing-and-health-care-reform-what-nurses-could-be-doing/) NP run clinics are cheaper, can be independent and still function without a Health Care system backing them. They also offer affordable health care access (and more importantly PREVENTION measures). If any of you want to argue the effectiveness or safety of NP’s see my post on NP care compared to physician care at http://nursestory.wordpress.com/2008/06/10/np-care-cost-effective-and-on-par-with-physician-care-according-to-research/.
• The Church. Although many churches could still care less about the health of their neighborhoods, are focused on filling pews and paying for buildings… some are ‘getting it’. For example, The Church Health Center (found at http://www.churchhealthcenter.org/) is fulfilling their mission of faith and caring for the sick.  If this would occur more, then health care reform would be much less needed (see post on Churches and Health Care http://nursestory.wordpress.com/2008/12/14/where-is-the-church-a-reflection-on-the-healthcare-crisis-christianity-and-organized-religion/)

What Can We Do

The average citizen feels helpless/powerless in this confusing, bureaucratic health care debacle, but we do have a voice. Below is a list of things that could be done to change health care and to give voice to those who feel disenfranchised. Maybe you do not feel disenfranchised, but would you be willing to speak for someone who is?

• Prescription Drug Costs: I am throwing this out there and many will balk at it, but what if no one paid for prescription drugs (when I say no one I mean no insurance companies…) How would the free market change the cost of health care if no one paid for drugs anymore? Would Wellbutrin still cost $200/month for 60 pills? How fast would the price drop if people were paying out of pocket? (then…. we would look at some charitable foundations that would help pay the bill for prescription drugs or maybe the government would provide a stipend to each person to pay for their own drugs….? Just throwing it out there as an alternative… something to consider.
• Nurses, nurses, nurses: If nurses were utilized more, particularly in preventative health care capacities (Which is what nurses are very very good at) then would costs be so high? What if someone with asthma could go and get asthma education and an asthma action plan without having a physician referral? What if nurses provided contraception education, diabetic foot clinic, immunizations, diabetes education, obesity prevention or weight loss clinics, etc…. how would the costs of health care be affected?
• Read and be knowledgeable: The best action for any citizen is to be informed of the truth (not the politics surrounding the issue). Politics, is a power game where our congress women and men could care less about our individual welfare and more on being reelected/retaining power. Don’t believe any of them. Instead I would read reputable health organization research like from the NIH, WHO, etc…
• Call or Write: At least provide a record of your opinions to someone. Call and write your state and national congressman (don’t just say you should… do it)… Also, write to an organization, join the cause, motivate your fellow civic and church group members to care…
• ACT: How would the world change if we all took some personal responsibility in this mess? Nurses, buy a blood pressure cuff and a good scale and be the neighborhood blood pressure/weight personnel. Citizens, join  your church in a health fair or donate to an organization that provides free health care. Likewise, all of us should strive towards financial freedom and responsibility. If we were not living pay check to pay check or in mounds of debt… how different would our society be? The government cares NILL about debt, but what if we as citizens began to care. Don’t go out to eat as often, pay off your car, check out Dave Ramsey….these small things give us more freedom to act where WE want to, not where others tell us we should. If we could act instead of being taxed into action, would that be better?
• The Church: Should be involved. This is exactly what the mission of Jesus was about, healing (often physical).  If the church doesn’t care about people (more than their memorization of scripture and Sunday morning attendance) who will?

The time is now. We have waited too long to help those who have no access or insurance. I see them everyday I go to clinic, where about 30% of the patients have no health insurance (that is why they come and see the NP and pay out of pocket). Many of them are putting off needed surgeries, treatments, medications… these people are real and there is very little to no help out there for them. I hate seeing people that I can not help because of financial difficulties. We are citizens of a free and amazing nation. We can make change.

References

The Church Health Center found at: http://www.churchhealthcenter.org/

The National Coalition on Health Care (2009). Health Insurance Costs. Found at: http://www.nchc.org/facts/cost.shtml

University of Maine (2001). The U.S. Health Care System: The best in the world or just the most expensive? Found at: http://dll.umaine.edu/ble/U.S.%20HCweb.pdf