In one of my must read blogs, Evan Falchuk cautions us over oversimplifying health care reform by using one New Yorker piece. The McAllenization of Health Care Reform

When we talk about health care reform, we are really talking about dozens of different issues. Is health care reform about covering the uninsured, or about cutting costs for employers? It is about having a publicly-funded health plan, or changing reimbursements to doctors? Is it about longer life expectancies or creating insurance cooperatives? Is it about caps on medical malpractice awards, or comparative effectiveness? Is it about healthier lifestyles, or cutting the cost of prescription drugs? Is it about cutting administrative waste, or incentives for more people to go to medical school? Is it about implementing new health care IT, or preventing insurers from making excessive profits?

It’s about all of these things, and more. And that’s the problem, if you’re an ambitious reformer. There is no simple way to get all of these things under one roof.

Well, until Atul Gawande introduced us to McAllen.

True health care reform should be complex. We have an illogical payment system that has perverse incentives. This has resulted in a maldistribution of our workforce – too little primary care (IOM definition) and too many subspecialists. We have divorced financial decision making from patients through an insurance industry that has not had incentives to really control costs, because they just increase their rates.

We have no free market in health care, and yet many worry that we will lose free market principles. We have accounting definitions of quality, and rarely explore the components of true quality health care.

We have an incredible plethora of expensive regulations, written under the guise of protecting patients and privacy. We are overwhelmed with unfunded mandates.

Too many physicians and entrepreneurs “game” the system, finding the profit opportunities without regard to our health. They can do this because they deal with bureaucracy rather than individual patients.

We have too many observers who do not understand that finding a way to provide care for the uninsured will actually save money. We will decrease ER visits and admissions through universal coverage. This likely would offset the costs (in my opinion), and it would be the right thing to do.

We have unreasonable documentation requirements that take the physician away from direct patient contact (our strength) and towards buffing the medical record. We have a tort system that worries almost every physician. Physicians clearly order unnecessary expensive tests because of their fear of lawsuits.

Yes we need health care reform, and I have no confidence that our current politicians will get more than 30% correct. They are bound to make mistakes that will make things even worse for patients.

Fortunately, we also have physicians who care deeply about patients. We will continue to do our best regardless of the changes. Some changes will be good and some will be horrid. And we have a responsibility to do our best for our patients.

Related posts:

1. Why this libertarian favors health care reform
2. Are the Democrats destroying health care reform?
3. What is wrong with health care
4. A few more thoughts
5. Thinking inside the box will not work – we need a new box

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