We have certainly heard enough recently about rationing and medical care for the elderly. And it is certainly pertinent, as many healthcare dollars are spent in the twilight of life for many Americans. I believe most physicians would agree that they have witnessed numerous cases of expensive procedures being performed when they were unlikely to prolong meaningful life. In many of the cases that I have witnessed, the doctors stand aside because of fear of litigation.
That is a shame. We are taught in medical school that we should take the lead on end-of-life decisionmaking. By doing so, we can take the burden of guilt away from the family and reduce friction between family members. It would be a worse shame to let those decisions be made by a faceless bureaucrat with no relationship to the patient. I believe doctors are capable of standing up and making the tough decisions if they are given liability protection when doing so.
My proposal would be to give physicians liability protection for withholding inappropriate treatments if the ethics panel of their community hospital is in agreement. I believe this would be better medicine, and the cost savings would be significant.
Next, there are already mechanisms to care for the uninsured. Most medium-size and large cities already have clinics, and in some cases hospitals, to care for the uninsured. In my town of Montgomery, Ala., we have the Medical Outreach Ministries clinic.
Unfortunately, funding to the Medical Outreach Ministries was cut by local hospitals as they felt the squeeze of declining Medicare reimbursement. Our clinic is not alone. Rather than come up with a whole new system, why not mandate community funding and expansion of those facilities already in existence? There are already dedicated physicians and nurses in place. They just need a little help, usually in the form of additional funding. This leads into my third proposal.
More tax money going to a federal bureaucracy will not facilitate efficiency. Instead, the federal government could mandate state and local governments to fund their clinics. I would feel much better knowing my healthcare tax money is going to help people in my community, rather than folks halfway across the country.
Additionally, local hospitals already care for the uninsured. Local communities should subsidize their local hospital's losses for that care. In exchange, local hospitals would charge these patients a fraction of what they charge the insured patients, instead of charging them more than the insured, as most do now.
Healthcare reform is possible. But drastic changes on such a large scale will turn out to be more expensive, with more waste and less patient satisfaction. We should be looking at ways to make communities responsible for their own people and to draw the physician and patient back together. My hope is that as time goes on, the politicians will eventually seek the advice of the people that actually care for patients: doctors, nurses and other healthcare professionals.
James Bradwell, a physician, is assistant regional medical director of ERMed, Montgomery, Ala.
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