The following is a guest editorial by one of the great icons of integrative medicine, Alan Gaby, MD. Gaby has been in the forefront of alternative/ integrative/ holistic medicine for as long as I can remember, and is past-president of the American Holistic Medical Association. I am honored that he allowed me to reproduce this essay for you.
Can We Save Obama Care?
By Alan Gaby, MD
It seems as if everyone is talking these days about how to fix the health-care system. Aside from my role as an advocate for better health care, I have a personal interest in seeing it fixed. My family’s medical insurance premiums are now more than $8,000 per year for a plan that has a $20,000 deductable, a plan that is essentially nothing more than a shield against some hospital’s confiscating my life savings in the event of a major illness or injury.
Not to whine too much when other people don’t have any insurance at all, but we all have a vested interest in seeing this thing fixed.
Well, actually, that’s not true. Special-interest groups who are making tons of money from the current health-care system would be quite pleased if it remained broken.
Who are some of those interest groups?
We can start with the trial lawyers. They are siphoning billions of dollars out of the healthcare system each year, raising the cost of liability insurance (which is passed on to patients) and causing doctors to practice expensive defensive medicine. Simple changes in tort law could save tens of billions of dollars each year without harming patients who have been the victims of true malpractice.
One such change would be to require that the loser in a malpractice suit to pay all legal costs; this would discourage the filing of frivolous lawsuits.
Another useful change would be to require that most malpractice suits go through binding arbitration, which is much less expensive than the current method of having high-priced lawyers and high-priced expert witnesses on each side.
Then there are the drug companies, who are the beneficiaries of a monopoly system that allows them to charge obscene prices for their drugs.
Drug companies charge Americans much more for some drugs than they charge Canadians, because they can get away with it. Allowing the reimportation of American drugs from Canada would save many billions of dollars each year, and the pharmaceutical companies would soon get the message and charge Americans reasonable prices.
It has been argued that squeezing the drug companies’ profits would stifle research and innovation, resulting in fewer medical advances. That argument overlooks the fact that most of the new drugs being introduced are simply repackaged versions of old drugs, or newer members of an old class of drugs that offer at best incremental advantages over the earlier products.
What these drugs do offer is a chance for the pharmaceutical companies to charge monopoly prices for another patent cycle.
Then there are the medical societies, who are often engaged in turf wars to protect the monopolies of their members.
Medical trade unions such as the American Medical Association have often tried to stifle competition by opposing licensing or opposing an expansion of the scope of practice for chiropractors, naturopaths, nurse practitioners, midwives, acupuncturists, psychologists, and optometrists.
The fact is that many of these practitioners are trained to evaluate and treat a wide range of common conditions for which patients would normally visit a medical doctor.
Allowing nonphysicians to practice within the full scope of their training would save a great deal of money, not only because these practitioners usually charge less, but because the number of doctor visits could be reduced.
For example, if psychologists were allowed to prescribe antidepressants, then many patients could work with just one practitioner instead of having to see a psychiatrist for their medication.
If more practitioners were available to deliver similar types of care, then patients would not have to wait so long for appointments, and more price competition would be introduced into the health-care marketplace.
Then there are the patients with the really good medical insurance. They want the most advanced, high-tech, expensive interventions available, regardless of cost, because someone else is paying for these treatments. But their employers can no longer afford these insurance policies, and the ever-increasing premiums are strangling our economy.
Then there are the people with Medicare and Medicaid, who also have very little incentive to limit their health-care purchases, because someone else is paying.
But Medicare and Medicaid are rapidly approaching bankruptcy, while at the same time the government is proposing to enroll tens of millions of currently uninsured people into similar plans.
The current health-care debate has centered mostly on how to bring the poor and the uninsured into the system. What the debate has overlooked is the fact that the health-care system is also about to collapse on the insured and the middle class, and it could bring the economy down with it.
Some hard choices lie ahead.
–Alan R. Gaby, MD
