Regarding your recent series of articles by the presidential candidates, there is agreement that many things are wrong with the delivery of healthcare, but few are addressing the real reason. The answer is simple. There is little concern about quality patient care at the bedside. As a direct result of this fundamental error, lots of activity circles the bedside, appears important and never lands with the patient. This activity drains the value away from the patient. Decisions based on cost rather than quality overlook the impact of error, excesses and excuses.
Error in judgment is prospective and retrospective. It is both medical and legal in nature. Real risk should bring to bear our concern only at the bedside, not the reward side. Incentives and rewards need to align themselves for best bedside medicine. Either system reform or collapse is likely. We can have a choice.
Excesses are extremely costly. Those things done defensively waste resources. Treatments such as delaying death cost. They reduce quality of life and consume financially. Fear is driving these measures. Redundant care and care systems compete for a finite number of cases as well as resources.
Excuses remove or defray responsibility and accountability. Here personal choices create waste. Years of self-abuse or lack of personal responsibility facilitate the entitlement mentality.
Until policymakers improve bedside quality and work to reduce excuses, excesses and error, expect a continued upward spiral of cost and a downward spiral of quality.
Ernie VestaMedical directorSmithfield Beef GroupGreen Bay, Wis.
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