Page 12 - Boca Club News - December '22

Page 12, Boca Club News
Medical Matters:

The American Health Care System (Part 2)

By Richard Nagler, M.D., a member monitoring. Their dismal records should be widely publicized out far too many citizens. As a result, colon cancer remains
of Broken Sound Club and retired and patients alerted to this, so that they may avoid them. one of the most common cancers.
physician. After graduating from the With most patients seen as potential adversaries, with Finally, something must be done to limit the excessive use
University of Pennsylvania and New ensuing malpractice litigation, frivolous lawsuits and of emergency rooms for problems that could be dealt with
York University’s School of Medicine, outrageous jury awards, insurance premiums charged to better and far cheaper in doctors’ offices. Capacity has been
Dr. Nagler served his internship and doctors and hospitals have risen dramatically. The threat of stretched to the breaking point. Patients often wait for hours
residency at Baltimore City Hospital malpractice litigation motivates doctors to order unnecessary to be seen, often in close contact with others with contagious
and Johns Hopkins. He followed that expensive tests and needless consultations with specialists to diseases, and many leave without ever being attended to. Staffs
with a Fellowship in Gastroenterology “share the risk.” Tort reform is needed, but has never been are overwhelmed and prone to serious errors of judgment.
at Yale University School of Medicine, and was then Chief seriously addressed by Congress. On the other hand, a much The bottom line is that we can’t afford to continue our
of Gastroenterology at Fitzimmons General Army Hospital greater effort to demand a high standard of quality care must present system of health care. It simply isn’t working for
in Denver. He returned to the Yale Medical School for one be made by physicians and hospitals. Organized medicine millions of Americans. The single-payer care systems—such
year as an Assistant Professor of Medicine before opening should assume greater responsibility for identifying those as Medicare for all citizens in other industrialized nations
his own successful private practice in Internal Medicine who don’t meet it and use their power to discipline effectively. like Canada, England, France, Germany and Scandinavia—
and Gastroenterology. During that time, he also served for We have an obesity epidemic in our country (40% of work well and at much lower cost. However, they do have
ten years as Chief of Medicine at Huntington Hospital in adults) that is responsible for many serious diseases and adds shortcomings. For example, in Canada many of their best
Huntington, N.Y. significantly to health care costs. Both the government and doctors have left and been replaced in large part by foreign-
The high cost of medical care has compromised doctors’ the medical profession have basically ignored the magnitude trained doctors often not up to previous standards. The costs
ability to deliver the quality of care that they are trained of this affliction and failed to promote a plan to effectively for some provinces have nearly bankrupted them. Canadians
to provide. With most practicing physicians now salaried deal with the root causes of this devastating problem. As a pay a personal income tax rate as high as 50%, mainly to pay
employees of for-profit managed care medical groups result, the purveyors of fast foods and soft drinks continue for their National Health Insurance plan.
and their income based on productivity, this has forced to advertise their dangerous products in the media. We have Waiting times for elective surgery and diagnostic studies
primary care doctors to see many more patients, ponder a continuing opiate drug problem in this country with too are unacceptably long. In England, many of the more affluent
over computer data and spend less time with them in order many deaths from over-dosage and countless lives ruined as Britons have opted for private insurance, which affords them
to maintain income. a result. preferential treatment. Thus, there is a two-tiered system with
The once common toe-to-toe comprehensive physical Not nearly enough attention has been paid to preventive the rich getting the better of it. In our country we have seen
examination has been reduced to a cursory one, in so many medicine, which can impact favorably on the development the emergence of “concierge medicine,” where for an annual
cases consisting of little more than listening to the lungs of serious costly diseases. For example, there are millions of fee (from $600 to as much as $5,000) one can have access to
and heart with a stethoscope, often with the patient still people with high blood pressure at serious risk to have a heart prompt attention by a doctor. This is a luxury only the wealthier
dressed. Instead, they tend to rely more on often unnecessary attack, stroke or kidney failure. Many have no symptoms among us can afford.
expensive tests, procedures and specialist referrals and and rarely see doctors. Others are under-treated or abandon Medicare is a good model from which to expand into a more
avoiding caring for the sickest ones who require the most medications, either out of ignorance or because of cost. There comprehensive plan for everyone. Ask any senior how satisfied
time. As a result, the doctor-patient relationship has become are 50 million people on statins, which have significantly they are with Medicare. There is free choice of physician and
seriously compromised. reduced the incidence of heart attacks, but there are many hospital, easily available physician referrals to a specialist and
Sadly, quality medical care has been short-changed, with millions more who should be on them. no denials for preexisting illness. The premiums are low and
many thousands of patients adversely affected and dying Routine colonoscopy—every five years after 50 the administrative costs are a fraction of that in the private
each year from hospital and medical errors. Although some (more recently moved back to age 40) or every 10 years sector. However, no plan can possibly succeed unless the cost
progress has been made with computerized records and if normal—has markedly reduced the death rate from of medical care is drastically reduced by addressing the issues
prescriptions, too many hospitals are notorious for their high colon cancer, but ignorance, apathy, unfounded fear of the I have discussed. Not to do so would make any plan fiscally
rates of these complications and are in dire need of careful procedure, pre-op preparation and the cost involved has left irresponsible and could quickly bankrupt the entire system.

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