BOOK
Update
About 10 years ago I wrote a book about the health care system. I was an advocate of universal health care and I am glad The Affordable Cares Act eventually became law. My belief is a balance can be struck between organized commercial medicine and government directed healthcare. Unfortunately, there are still parts of the health care systems that I wrote about in the book that are still concerns; like access and affordability. We spent $2 trillion annually on healthcare 10 years ago. Today we spend $3.5 trillion. My book proves to still be relevant today and my solutions are still worth exploring.
Years ago before the Obama- McCain presidential election I wrote, “Healthcare could decide the next presidential election if the uninsured and seniors rallied together with one voice around this critical issue.” Seems the more things change the more they remain the same. Below are some excerpts from my book.
McFly Goes to Med School can be purchased on Amazon.com.
Order your copy.
The Book
This book presents a plan that controls healthcare spending and provides coverage for 47 million uninsured Americans, without taxing the general population, and without a government administered universal health program.
To understand healthcare one has to understand the players. This includes physicians, hospitals, insurance companies, government, drug companies and lawyers. Nothing starts in this $2 trillion a year industry called healthcare without the physician. Yet the physician seems as powerless a participant as the uninsured. How did this happen?
Most people do not realize that the U.S. will have a deficit of 100,000 to 200,000 physicians within the next ten years. How will this shortage be addressed?
Healthcare is a right not a privilege. Our elected officials take an oath of office to defend the Constitution against all enemies foreign and domestic. Every year over 18,000 people die unnecessarily because of being uninsured. Real solutions are needed to combat this deadly domestic enemy.
The last chapters of this book list the names, addresses, phone and fax numbers of all members of Congress. It is time for the voices of 47 million uninsured Americans to be heard.
What Value Can One Put On Health?
Questions, Answers and the Solution
How much would you pay for a cure if you had lung cancer? How much would you pay if your child needed a transplant? Would you exhaust your savings? Would you sell your house? Would you ask everyone you knew for money? If it meant living right above the poverty line, but you were cured or your child got the transplant, would it have been worth it to lose everything?
We spend so much time protecting our possessions. We spend so much time squirreling away our nuts to prepare for retirement. What does any of it matter if you or your child dies in six months? I, like you, don’t even like to think about those things.
When the republican white house press secretary, Tony Snow, announced his cancer had returned a week after the wife of the democratic presidential candidate John Edwards announced her cancer had returned, who cared about their politics, except Rush Limbaugh? When cancer hits a family, it is like throwing a brick through their window of life. I was so sorry to hear about the passing of Mr. Snow. He always conducted himself in a professional and truthful manner when I saw his press briefings. I remember the sudden passing of David Bloom years ago while covering the gulf war from what appears to have been a blood clot. Weeks ago Tim Russert passed away after a sudden heart attack. From the outside looking in, I believe they were all were individuals dedicated to their family and their careers. Illness changes everything.
Illness and death has does not favor republican over democrat or vice versa. We are all Americans and have to fight together for the sake of all our families.
No one today in America should die of colon cancer, breast cancer, prostate cancer, cervical cancer or ovarian cancer. We are spending a lot of time and money looking for cures we already have for most cancers. The cure is prevention.
Convincing people about the value of prevention in this country is the equivalent of trying to convince a billionaire of the value of balance his check book. As long as volumes of money keep coming in, who cares about balancing the check book? As long as we have volumes of money to spend on health care for procedures, technology and drugs to fix us after the fact, how dedicated is anyone to preventing a medical problem in the first place?
To insure all Americans we had better start paying closer attention to prevention. 47 million Americans are without heath care insurance; that’s one out of six Americans. Almost two thousand people died in Katrina. More than three thousand died on 9/11. This year as many as 18,000 Americans will die for reasons associated with being uninsured. Next year another 18,000 will die. The following year another 18,000 will die.
It has taken me two years to write this book. I wrote portions of it on four continents and in more than six countries. On my trips I watched people. I saw them come and go. I saw them laugh and cry. Whether in Kuala Lampur; Malaysia; Bogota Columbia; Amsterdam, Netherlands; Vancouver, British Columbia; Flint, Michigan; or New Orleans, Louisiana, people are people. Not one life is more or less valuable than another. Everyone, if given the choice, wants to live.
Can the powers that be find a way to prevent the death of another 18,000 uninsured Americans this year or next? Is it important enough to them?
Read more about this topic in chapter XI “EVERYONE HAS A RIGHT TO PROPER HEALTHCARE. People Are People” of “McFly Goes to Med School”.
The Uninsured
I have had many conversations with people about the tremendous number of uninsured in America. Many believe the uninsured are lazy individuals that do not want to work and only want to live off others’ tax dollars. Granted, some people fit that description, but that is not the case for the majority. Most of the uninsured are working Americans, employed by small business owners that cannot provide health insurance.
They are your barbers and your beauticians. They are your cleaners and your convenience store workers. They are your landscapers and your house painters. They are your childcare workers and your church support staff. They are several people that live on your block, down the road, or in your subdivision. They are your neighbors and the children of your neighbors.
They are your family of four without a preexisting illness, that cannot foot the bill of one thousand dollars per month for basic health insurance. They are your family of four in which Mom has diabetes and one of the children has asthma, and because of the preexisting conditions they are looking at possibly two thousand dollars per month for health insurance. They are your family of four that pray every night for a job with health benefits. They are your family of four that see their small life savings wiped out by one unexpected health mishap. They are your family of four that get strange looks at the doctor’s office when they state they do not have health coverage.
What family of four am I talking about? The next time you drive home, count houses. Living in every sixth house is that family of four to whom I refer. Are we our brothers’ keepers? You’re darn right we are. We had better be, because one day we may be the ones living in that sixth house on the block.
One in three Latino Americans is uninsured. The limited number of bilingual Spanish- and English-speaking physicians will become more and more of a problem as the Spanish-speaking segment of the population begins to grow. If one is an African American who has historically not accessed the U.S. healthcare system but finds himself in an emergency room suffering with chest pain, at least he can communicate in English with healthcare providers regarding his symptoms, history, and any other pertinent information. If you a Latino that does not speak English and have not accessed the U.S. healthcare system, and arrive in the emergency room with chest pain, communication between you and your provider is a frustrating problem for both.
On a side note this is not the place for the debate “everyone needs to speak English”. When ordering a ham and cheese sandwich or entering the work force, “speaking English” can be discussed there appropriately; not when we are talking about life and death.
Lack of proper communication in the ER can easily lead to one of two situations: either misdiagnosis or the ordering of unnecessary tests and procedures as the doctors try to cover all the bases. Neither situation benefits the patient or the taxpayers. Hospitals and clinics try to use telephone services for translation help. Sometimes the children of the patients are asked to translate. Even with this go-between, there is increased risk of morbidity and mortality due to misinformation or miscommunication. Considering that Latinos are the largest minority group in America, this problem will only get worse.
Read more about this topic in chapter X “PRIMARY CARE AND MINORITY PHYSICIANS. We Need Help-Today”, of “McFly Goes to Med School”.
Health Disparities
Access to primary care is critical to reverse the disproportionate rates of increased morbidity and mortality rates among minorities, particularly African American groups, in almost every disease category. African American women have higher infant mortality rates, 13.60 deaths per 1,000 live births (CDC 2004 report), compared to white women, 5.66 deaths per 1,000 live births (CDC 2004 report). A comparison of the U.S. infant mortality rate compared to other industrialized nations is the statistics experts like to routinely trot out as evidence of the breakdown of the U.S. healthcare system.
The U.S. spends more money per capita on healthcare, yet there are thirty plus nations with lower infant mortality rates. African Americans, Hispanics, Native Americans, and Asian/Pacific Islanders have higher infant mortality rates, lower life expectancy rates, and higher rates of cancer and cardiovascular disease than whites. Here is an eye-opening statistic: although Latino Americans and African Americans make up greater than 25 percent of the population, they only comprise 6 percent of all physicians in America. Asian Americans comprise 6 percent of the population but 16 percent of all physicians. The lack of African American and Latino American physicians is particularly alarming since recent studies have shown that at times majority physicians unintentionally may not be as attentive to the dynamics and cultures of minority communities.
Medicine is not just the objective evaluation of a patient’s medical condition; it is also about subjective evaluation of a patient’s social condition. One can prescribe all the drugs in the world, but if a patient cannot afford to purchase the drugs, there is a problem. If you tell the patient to come back for a critical procedure but the patient has no transportation, there is a problem.
Whether it’s right or wrong, my experience is that minority patients feel more comfortable with physicians who look like them in the same way a significant proportion of women patients feel more comfortable with women doctors. The comfort I refer to is not about feeling a lack of competence or mistrust in the quality of medicine provided by majority physicians when they see minority patients. Some patients feel that when someone looks like them, that person understands what their lives are all about, without them having to explain it. Dr. Edith Fresh at Morehouse School of Medicine has lectured extensively on this issue of “cultural competency.” We must address the disproportion of minority physician representation. There needs to be a greater effort to encourage young African American and Latino students to pursue a career in medicine.
To read more about this topic read chapter CHAPTER X, “PRIMARY CARE AND MINORITY PHYSICIANS. We Need Help-Today” of McFly goes to Med School.
Bennett Health Plan
First let’s get one proposed solution out of the way: government-regulated universal healthcare like Canada. Forget it. That system will not work in America for many reasons. I’ll discuss the most important one. America is a “right now” society for everything. We don’t wait for anything. Not only do we not wait; we become indignant when we are forced to wait. I have seen people go ballistic waiting for a latte. The Canadian healthcare system is all about waiting.
I am sorry; I’m over forty and if I have chest pain, I want to get worked up today to ensure I am not having a heart attack. I do not want to wait to see a cardiologist. I do not want to wait to get a stress test. I do not want to wait to get a cardiac catherization. I certainly will not wait in line until it’s my turn to get bypass surgery.
Another reason the Canadian system won’t work here is that 47 million Americans do not have healthcare coverage. That’s 10 million more people than the entire population of Canada; which is about one-tenth that of the U.S. Ten times larger means ten times more headache. This reminds me of the debate in 1992 between Governor Bill Clinton of Arkansas, President George Bush, and Ross Perot. Perot was addressing Bill Clinton’s “lack of experience.” Someone reminded Perot that Clinton was the governor of Arkansas. Perot’s response was that just because someone can run a general store doesn’t mean you give them the keys to Wal-Mart. Canada: the general store, America: Wal-Mart.
POLITICS
I have long given up the notion that changes in the healthcare system will come about because of compassion for our fellow man. It is sad to say that the only thing that really drives change regarding any situation in this country revolves around two areas: number one is money, number two is politics. On the other hand, maybe number one is politics and number two is money. Either way, if we are going to look for solutions to the health care dilemma, those solutions will have to incorporate either a profit motive or political motive.
You can forget about politicians cutting wasteful spending in other areas to free up funds to improve healthcare. Remember, one man’s pork is another man’s dinner. I vote for your dinner today and you vote for my dinner tomorrow, wink, wink. Pork gets politicians reelected to office. In general it is safe to say that most politicians are motivated by whatever issues allow them to stay in office. If the issues do not matter in polling, the issues do not matter to them. That’s fine. As individuals concerned about healthcare, we need to know the political motivation factors and work those factors to our advantage.
Most polls will show that many Americans put healthcare in the top three areas of concern, the economy and the war being the other two. But while the situation in Iraq has forced politicians to take a stance for or against, there has been no such definitive stance for politicians in regard to the issue of global healthcare for all Americans. They all talk a good game, but are they committed?
Here then is the first step toward finding a solution and getting the team together. If you are an uninsured American, if you see no prayer of ever getting healthcare from your employer, if you are concerned about yourself or your loved ones getting sick and wiping out your life savings, you need to make just a few telephone calls.
On this web site I have provided the names, phone numbers, fax numbers and addresses of all U.S. representatives to Congress and the Senate, state by state. First call the local office of your local U.S. congressperson. Let the person who answers the phone know that you are a member of the congressperson’s district. Ask to speak directly with your congressperson. If you are unable to speak with them directly, then ask to set up a meeting with your local congressperson. Their representative will continue to do a tap dance on the telephone, trying to appease you in an attempt to avoid letting you speak directly with your congressperson. Try your best though to get that appointment or phone conversation. Once you are able to speak directly with your local congressperson via a telephone call or in person, ask them the following: “I am an uninsured American. Will you actively support legislation that ensures that I will have an opportunity to secure affordable healthcare coverage for myself and my family?”
After the first dodge to avoid answering the question by your congressperson, repeat the question: “I am an uninsured American. Will you actively support legislation that ensures that I will have an opportunity to secure affordable healthcare coverage for myself and my family?” If you cannot get a clear yes to that question, it’s time to consider voting for the other guy.
Let me make this clear: if you are uninsured, there is zero chance of you being insured without the intervention of Congress. Making a few phone calls or taking a trip to your congressperson’s office is not an unreasonable step if it gives you and your family a shot of getting healthcare coverage. If you get a yes, you vote for him or her. But, if you get a no or a response that is a little bit foggy-a little bit unclear-and you are not certain if the response was a yes or no, vote for the other guy.
Once you have accomplished that task with your congressperson, the next step is to call your U.S. senators and repeat the drill.
Once you meet with your senator or have your senator on the telephone, ask the following question: “I am an uninsured American. Will you actively support legislation that ensures I will have the opportunity to secure affordable healthcare coverage for myself and my family?” If the answer is yes, vote for them; If no vote for the other person.
What if you’re not in a district or state where your Senator is not up for reelection in the next cycle? That is okay. Ask the questions and get an answer. At least you know where the people who represent you in government stand. Call all the representatives in your state if you can, and ask the question. The important thing to remember here is you are not doing this by yourself. You have 47 million friends. You have to know that you are not alone; you have to know that your effort will not be in vain. You need to inform and encourage uninsured individuals you know to perform the same exercise with their Washington representatives.
This is your opportunity to empower yourself. You no longer have to be a victim. This one issue and this one effort by uninsured Americans can literally decide the next President and the next Congress of the United States. Do your part.
We can talk about the war, we can talk about abortion, we can talk about immigration, we can talk about the economy, we can talk about gay and lesbian rights, we can talk about stem cell research, and we can talk about tax cuts. But for you, an uninsured American, there is no greater issue that affects your life-day in, day out-than the issue of not having healthcare insurance. Forget about all the other platforms. Forget about being a republican, forget about being a democrat, forget about being an independent, forget about being a libertarian, and forget about being a member of the green party. You need to vote for the presidential candidate who will actively support your agenda of securing affordable healthcare.
Without proper healthcare for you and your family, you are literally walking through a minefield every day. Without notice and without preparation, a healthcare tragedy can strike you or your family. What would your stance on the war matter or your stance on abortion matter then? What would your stance on the economy or your stance on stem cell research matter then? What would your opinion on taxes matter if severe illness strikes you or your family? Do not be swayed, do not be moved, do not compromise, do not bargain, and do not retreat! This is your issue for the next election. Make your voice heard. Once the politicians understand how serious we are; more importantly, how numerous you are; and most importantly, how willing we are to vote, they will have to act or lose their jobs.
To read more about this topic read CHAPTER XII, “THE BENNETT PLAN FOR THE U.S. HEALTHCARE SYSTEM” of Mcfly Goes to Med School.
US Congress
We are closing out one of the most dysfunctional Congresses in US history. We can only hope with the end of the election that both Republican and Democrat make every effort to work together.
After the election we all need to remember that we are all Americans. Its not Republicans or Democrats that fight our wars; its Americans. Its not Republicans or Democrats that are on Medicare, Medicaid Social Security and disability; its Americans. Its not Republicans or Democrats that live in poverty; its Americans. Its not Republicans or Democrats that are unemployed; its Americans.
We have significant issues to conquer; the deficit, unemployment, health care and national infrastructure. Lets put the partisan politics aside and begin a new exciting chapter of American history.
If we have a President Obama, I want to see him stand at a podium, at the White House, endorsing Republican ideas that move the country forward.
If we have a President Romney, I want to see him stand at a podium, at the White House. thanking the Democratic leadership for ideas that move the country forward There arent partial winners or losers in this game. We all win or we lose together.
Physician Shortage
A little-known fact to the American public is that the United States is expected to have a physician shortage of somewhere between 100,000 and 200,000 by the year 2020. After more than a decade of denying that there would be any shortage of physicians in the future, the American Medical Association called for a 15 percent increase in the number of medical student graduates by the year 2015; a number that has recently been increased to 30 percent. Even under ideal circumstances, if that request was implemented by all U.S. medical schools, there would still not be enough new physicians trained to meet the projected need.
The medical school side of the equation is only one side of future medical education concerns; every medical student has to get additional medical residency training after graduation to become eligible for licensure to practice medicine in the United States. Currently there are approximately one hundred thousand residency positions in the United States. The cost of training one medical resident is approximately $100,000 per year. The total annual cost for medical resident education then would be approximately $10 billion. The funding for medical residency training primarily comes from Medicare. Funding also comes from the Veterans Administration (VA).
There was a cap placed in the mid-’90s on increasing the number of residency positions because of the projected “surplus” of physicians. The cap would of course have to be adjusted upward to meet the demand for more residency training positions in the next fifteen years. But once again, increasing the number of residents places further burdens on the budget of Medicare and the Veterans Administration system. If medical schools doubled their number of graduates, another $10 billion per year would be needed for medical residency training. Considering the current funding struggles of Medicare and the VA, where is the money going to come from?
One may ask how we got ourselves in this position to begin with. We can start is in the mid-’90s when the American Medical Association accepted a prediction that there would be a future surplus of physicians by 2000. In fact, the opposite has occurred. The number of first-year MDs enrolled per one hundred thousand of population has declined since the 1980s. In the 1980s the U.S., for all intents and purposes, stopped opening new medical schools. Now, as the U.S. population increases, baby boomers are reaching senior-citizen status, demanding more medical resources; senior physicians are retiring; and new physicians want to work fewer hours. So that prediction of a surplus of physicians was woefully “inaccurate,” to say the least. All discussions and proposals on the table surrounding the pending physician demand have to be entertained.
Approximately 25 percent of the physicians practicing in the United States are international medical graduates or foreign medical graduates. These are medical students or doctors who trained abroad, then applied to U.S. residency programs. Once their programs were completed, they became physicians licensed to practice United States. Most studies show that international medical graduates are more likely to practice in underserved areas such as inner cities and rural counties than their American counterparts are.
When looking at primary-care specialties, recent data also indicates that almost 50 percent of the IMG (international medical graduates) chose careers in primary care compared to approximately 30 percent of U.S. medical school graduates. International medical graduates face serious obstacles and the perception of inferior training (and therefore competency) by hospitals, residency directors, and patients. International medical students or physicians with heavy accents have added difficulty being accepted by patients and the general medical community. The bottom line, though, is we need them. Currently U.S. medical schools produce more than six thousand too few doctors for available residency positions. International medical doctors fill approximately 25 percent, or 6,000 slots, of the available residency positions each year.
The greatest obstacle international medical graduates face is not having adequate U.S. clinical experience. Most have finished medical school and residency in a foreign country and have no real U.S. clinical experience in the outpatient or inpatient setting. Lack of U.S. clinical experience means lack of familiarity with equipment used in hospitals, U.S. patient culture, administrative paperwork, and the standard protocols that are followed by U.S. medical school graduates.
Because of a perception of “patient safety,” international medical doctors have a difficult time finding private physicians or hospitals that would be willing to allow them access to patients, which would enable the foreign medical graduate to gain the clinical experience necessary prior to applying to U.S. residency programs. As with U.S. students, an attending or teaching physician must supervise and teach international medical students during a clinical rotation or clerkship. But unfortunately, as stated earlier, there are not enough attending physicians or hospitals willing to give the foreign-trained student doctor a chance to learn in a real clinical setting.
There is a perception of harm to the public when referring to foreign-trained medical doctors, even though most of those doctors have successfully passed the same medical board exams as their U.S. counterparts. Many of these foreign-trained doctors also practiced for years in their country of origin prior to coming to the United States, giving them more real-world experience than new U.S. doctors just out of medical school. Yet as a group they are essentially considered “less than” in U.S. medical circles. If one speaks to some of the foreign-trained doctors who have been successful, they will tell you how much harder they felt they had to work to gain the respect of their U.S. peers.
The story is no different from the perception of blacks being intellectually inferior to whites. To get past the negative perceptions, blacks of previous generations had to work harder to prove their worth. There are some that will argue that is still the case. This is the current plight of a foreign-trained doctor who wants to practice in America. To make public perception worse, it seems media has no reservations about sensationalizing a negative story that involves foreign-trained doctors. I have been in medicine as a student, resident, or practicing physician for sixteen years now. I cannot recall one news story in that time that focused on the value foreign-trained doctors have in this country. I guess that would not sell newspapers.
Foreign-born and trained medical graduates are not the only individuals who attempt to come into the U.S. healthcare profession. There are Americans who were not successful in getting into U.S. medical schools and go abroad for their medical education and wish to come back to the U.S. for residency.
Thousands of foreign-trained Americans gain acceptance to U.S. residency programs each year. Offshore-trained Americans encounter the same problems as foreign individuals who attempt to come into the country to get into residency; they lack U.S. clinical training experience. They too have difficultly getting into hospitals to gain critical experience, without which they will not be viable candidates for residency.
A reasonable concern of hospitals is the standard of medical training the student received from his or her foreign medical program. There are approximately 1,900 medical schools in 172 countries around the world. Standards differ in each country. One can easily see why residency directors are very skeptical and make every effort to avoid accepting international medical graduates into their programs if they are able to fill their positions with U.S. medical graduates.
However, there are not enough U.S. medical students going into primary-care specialties, thus making it imperative that international medical graduates fill the void. When to rubber meets the road and the predicted physician shortage becomes reality, especially in primary care, decisions in medical education we make today, which are exclusive instead of inclusive of foreign-trained doctors, will hurt all Americans dearly.
To read more about this topic read CHAPTER VIII, “MEDICAL EDUCATION Part 1; America Will Need a Lot More Doctors”, of Mcfly Goes to Med School.
