Market doesn't work for health

By James Binder, M.D.
The Charleston (W.Va.) Gazette, Feb. 27, 2013

A major shift is occurring in health and no one seems to be noticing. Computers have taken priority over patients. Wow! It doesn't matter whether the patient is seen in the emergency room, a physician's office or in a hospital, completing documentation on the computer is paramount. The patient better stay out of the way.

Is it impersonal? Of course. Is it a problem? Certainly. Over and over again, medical research has demonstrated that a physician's ability to engage with the patient and create a strong therapeutic relationship is the best predictor of positive health outcomes.

How did we come to this point in health care? My belief is that the answer is clear and simple. We have allowed health-care decisions to be made by a fragmented business conglomerate in which profit is the chief motive. The marketplace has never and will never work for health care.

Private insurance companies spend 31 percent of the health dollar on advertising and an excessive bureaucracy, instead of for patient care. The idea that competition will lower costs has not worked despite 50 years of trying. When we become ill and vulnerable, which we all will at some point in our lives, we are not in a position to be discriminatory consumers in the marketplace. Even if we were, 50 percent of us live in areas, most often rural, where there is no choice.

To foster the transformation to electronic records, proponents of the marketplace approach told us that digital electronic records would improve the quality of health care and save money. They lobbied very hard to get legislation passed in 2009 supporting the use of electronic records in health care.

It did not save money for consumers. The cost of health care continues to skyrocket. It did bring windfall profits to a few strategically placed companies in the medical-industrial complex. The New York Times reported Feb. 19 that AllScripts doubled its sales from $548 million in 2009 to $1.44 billion in 2012.

With time, we are likely to learn more flexible ways of using computers so they don't act as obstacles to a solid physician-patient alliance. The second problem may be more difficult to resolve. If we employ a fragmented, competitive marketplace model, companies will continue to create expensive electronic digital systems that do not communicate with each other. Their goal is to maximize the billing potential of hospital and other providers they serve. Solving this problem will require us to change our health-care financing method.

We could benefit from the use of digital electronic records if we followed the example of the Veterans Administration. It established an infrastructure in which each VA treating facility is able to assess medical records from any other VA medical provider, as well as from the Department of Defense. Clinicians have access to a patient's diagnosis, medications and previous treatments in an instant.

In addition, the digital electronic program has been designed to assist primary-care clinicians as they provide comprehensive, preventive and evidence-based care. Electronic reminders address specific relevant health-care issues periodically and goals are tracked across time.

We could have similar unified and coordinated electronic medical records if we established a national program for financing health care. It is called single-payer health insurance.

For a discussion of single-payer, how it would operate, as well as learn about the Affordable Care Act, please join us at 7 p.m. April 25 at the University of Charleston. Participating in the discussion will be Andy Coates, M.D., president of Physicians for a National Health Program, and Perry Bryant, founder and executive director of West Virginians for Affordable Health Care.

Dr. Binder practices pediatrics at Cabin Creek Health Systems and is the author of "Pediatric Interviewing: A Practical Relationship-Based Approach" (2010) and "Primary Care Interviewing: Learning Through Role Play," to be published by Springer in 2013.