Major Failings of the American Healthcare System and Ideas for Fixing Them

With a lifetime of experience in the practice of internal medicine, taking care of wealthy, well-educated patients, as well as those at the low end of the economic curve, and participating in numerous medical delivery organizations, I believe I can give some cogent answers to many of the failings of our healthcare system.Since the end of World War II we have led the world in progress in medical science and in many areas of clinical excellence. In spite of this our health statistics...
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With a lifetime of experience in the practice of internal medicine, taking care of wealthy, well-educated patients, as well as those at the low end of the economic curve, and participating in numerous medical delivery organizations, I believe I can give some cogent answers to many of the failings of our healthcare system.Since the end of World War II we have led the world in progress in medical science and in many areas of clinical excellence. In spite of this our health statistics shows that we are at, or near, the bottom of the world's developed nations. Our healthcare costs are close to 18% of our gross domestic product. Only three other countries are over 11%, and the international average is under 10%. In spite of the high spending, we have one of the lowest life expectancy rates in the developed world. This, is due to very complicated factors, including variable economic and education levels in our population.Our share of the population without health insurance--public or private--is also one of the world's highest, and has fluctuated greatly, but without major improvement.In this book I have taken a thorough look at these statistics, and using my years of experience, focused on the many causes of our failings. I have attempted to tie together the numerous causes and then have, most importantly, moved on to look at how Federal and state government, health care organizations such as hospitals, medical schools, private insurers, the physician community, and individuals interact to contribute to the failings, and ultimately how to fix them. Among the remedies, the most discussed will be how individuals can help in their own lives, as family and community members, and inter-actors with government and insurers. For example, community "villages", where people work to postpone the day when partially infirmed seniors need to go to supervised facilities, could make a modest difference. The deficiencies of the medical practicing community are variable, but the recent onslaught of opioid addiction, and deaths is an example of a flawed medical community, though the pharmaceutical industry, and certain drug distributing organizations can share some of the blame. In looking at our health care costs compared with other countries, one of the most blatant and easily evaluated, are the differences in pharmaceutical costs. It is frequently a gross exaggeration when US companies blame high costs on research and development. In very recent years, however, genomic medicine and the use of the immune system to develop therapies for certain cancers has been very rewarding clinically, but the cost of many of these drugs has been extremely expensive--at times over $100,000 per year. There is some evidence that this cost, and the work leading up to it, are quite exaggerated beyond the honest rules of business finance. This could be an example of the government, or a consortium of private consumer insurers forcing a reduction in the costs.An area I have discussed in the healthcare reorganization of primary care practices is the "Patient Centered Medical Homes" where the appropriate use of ancillary personnel, and proper planning by the physician leaders can cut costs. I will cover going onto a hospital ward, and observing the efforts to reduce in hospital injuries or other causes of readmission are beginning to be an important part of cost reduction, and many are simply based on not very sophisticated statistics, but common sense. As I present the book, I hope to educate the reader in what the Government must do to lower our health care costs, what insurers, hospitals, and the medical profession should do to reorganize the system, and what we as individuals and citizens must do to make ourselves more careful patients, and more caring and knowledgeable in dealing with governments and professional organizations.