The non-political political post

10 10 2012

This week, the New England Journal of Medicine published two side-by-side editorials: one written by President Barack Obama, one by Mitt Romney.  They ran alongside one another, and both were written to physicians in general, and both attempted to persuade the reader that his approach to health care reform was superior.

I won’t give my opinion, except to say that both articles contained equally-sized, steaming piles of crap and both made sure to address the need to reform malpractice litigation (a huge issue facing health care which I have not heard either candidate mention since the campaign began, aside from these editorials).

Picture, though, that our health care system is like a very complicated patient being seen in a primary care clinic.  The patient is sick, but not in acute distress.  The patient has been transferred to your clinic and his medication regimen is a mess, taking a combination of 30 prescription drugs and supplements.  As that patient’s physician, you have a choice in how you manage those meds.  Your options are:

  1. Stop every medication and start fresh with an entirely new regimen, or
  2. Go slowly, changing or eliminating one medication at a time and evaluating the response.

Every medical student, probably every health care worker, and likely most normal people would choose option number 2.  Why?   Well, that is obvious: completely eliminating the previous meds could cause all kinds of havoc, including potentially deadly withdrawals or crises of the conditions that the meds were treating.  Changing one thing at a time also allows the physician to evaluate the effects, decide whether that medication at that dose is truly necessary or doing more harm than good, etc.

So if this is clearly the better option, why have both Obama and Clinton, two presidents who recently attempted health reform (and I say attempted because Obamacare may very well fail), opted for the much more drastic and potentially dangerous option of radical, sweeping reform?

In short, it is because they have to.  Our government is not built for long-term, gradual change toward a unified goal.  With the head of state nearly guaranteed to represent a different set of beliefs and visions for the country every 4-8 years, every one of those men knows that in order to accomplish anything, he has only 4 years to make a change assuming he won’t be re-elected (really, 2, if you subtract the time it generally takes for the new legislation to pass through Congress).  Returning to the patient analogy, if you cut out or change only 5 of those 30 medications and the patient then transfers to a new doctor after 4 years, that physician could easily decide that he liked the previous regimen and he would have time to change all of those medications back to how they were.

The net progress: null.

If the change is wide, sweeping, drastic, and based on a framework that is almost entirely new, it is much, much more difficult to revert back to how things were. For example, when Massachusetts began to require universal health insurance coverage, it was a huge step and has had positive results.  But that was a comparatively small change to one part of the law in only one state.  Relatively easy to reverse with the right combination of people in office.

Every president wants to leave his unique legacy in the pages of our history books.  I would want that, too; who does not want to be remembered for something that he or she did, even generations after stepping down from the position?  Making this mark as permanent as possible comes at the cost of potentially risking the health and well-being of millions of people all at once.

In fact, if the physician in our analogy opted for route A, there would be a very real risk of that patient experiencing withdrawals, perpetuating side effects that had previously been in check by another medication, dealing with vitamin deficiencies,  suffering a wide range of potential discomforts, and even putting that person’s life at risk.  The potential cost:benefit ratio is so high that, depending on the situation, the physician could be sued if the smallest thing went wrong.

Our bipartisan governmental structure is not conducive to making the kind of changes we really need in health reform. We need to be able to eliminate or tweak each facet of the system, one by one, with long-term, unified, achievable goals in mind.

But hey, what do I know?  I’m no politician.

Thank goodness for that 🙂




One response

10 10 2012
Hector Sanchez

Excellent articles! I really like the way you use comparisons & examples. Hope you keep this blog going, its always great to see new posts!

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