Direct to Consumer Care
One of the biggest challenges in America is providing low cost care to the uninsured or those who can no longer afford a typical insurance plan. Even a modest family plan would cost at
“I ask our over regulated medical bureaucracy to think practically.”
least $6.000 if not subsidized by the employer. Our problem is we force uninsured people to go where they will be treated, that is, emergency rooms. We force insured people to see expensive physicians for anything that may require a prescription no matter how routine.
The most affordable system would be to treat people where they shop. A Kaiser Health news story this week discussed how internal Wal Mart documents show a plan to get big in retail clinics. CVS already has over 500 mini clinics. We have the greatest and most expensive technology available for use in the nation’s hospitals. That does not mean we need it for the vast majority of medical problems. We need places for basic care, most of which can be done by well-trained nurses or physician assistants.
We need to get over the mystique that medicine is somehow a super skill that only the best and brightest can perform after 4 years of specialized education. While I do not advocate going back to the barber/surgeon days, we can at least trust most medical problems to be diagnosed and treated by less trained professionals.
Doctors are obviously needed for the non-routine diagnoses, but most diagnoses are routine. The physician lobby will say a nurse may miss some hidden underlying condition. Yes in a rare case this is true and someone may have meningitis instead of a headache. The issue is one of pragmatism. We can afford to treat every American when they are treated by a $30-40 an hour nurse, but not when it is a $150 an hour specialist. All the Dr. Houses are still available for the complex cases.
Our government needs to let people be treated by the lowest cost method that gets the job done adequately. If that means letting the masses get their basic care at their drug store, chain store, or food store then so be it. We may all want the top physician to see us for everything but who can afford that? The AMA will scream about all the risks of letting nurses treat and prescribe. The truth is most people would rather have some professional see them right away then face a month wait to see the specialist.
Our current practice of medicine is only a few decades old. Even I remember seeing only one doctor as a kid for every type of ailment. He came to my house when I was too sick to travel. Yeah maybe he missed something that a super trained specialist would have found, but remarkably I survived to middle age. In the 1970’s we got the idea that everyone wanted and needed a specialist. Those same specialists would diagnose the same cold, earache, stomach flu, and treat them the same as my family doctor. The only difference was they charged more and saw me less.
So I ask our over regulated medical bureaucracy to think practically. The goal is mass treatment and prevention of the most common ailments. Train more people to diagnose the most common conditions and we will create hundreds of thousands of new jobs. All those unemployed English majors can get 6 months of earache, wound cleaning, and strep testing training and they can solve most of our health care crisis. Sometimes less is more. We can always find examples of how experience makes a big difference in finding a hidden condition. It is true that someone may die from seeing a less experienced practitioner who missed something. On the other hand, many more will get the care they need when they need it for a price they or we as a nation can afford.
Being broke can make one a pragmatist. It is time our insolvent Congress and States passed pragmatic ways to treat people. I guarantee if we never heard of our current system we would never invent it or desire it.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.