Category: Health Care System

Health Care Foibles – A Personal Tale

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An example of the stupid things even doctors do when it comes to health care. 

By Mark D. Harris

In March of 2013 I wrote Healing the Health Care Cost Conundrum. Four years later, in March of 2017, I have retired from the US Army and am practicing medicine in Memphis, TN. My practice is in the inner city, and our focus is serving the Medicaid population. Our patients are impoverished and often very sick, with chronic diseases frequently showing up 20 years earlier than in their more affluent counterparts. Many live in dangerous communities, have no reliable transportation, and have unhealthy food. Obesity is the norm, violence is taken for granted, and serious mental illness is widespread. It comes as no surprise that many patients abuse drugs, citing chronic pain that may or may not be real. Some come to the clinic for no other reason than to feed their drug habit, and try to get narcotics to generate a little extra income. It is the toughest medical environment I have encountered since my combat tour in Iraq.

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The Next Surgeon General

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What should the US Surgeon General be like?

By Mark D. Harris

As Donald Trump prepares to assume the presidency, media outlets are aflutter with his nominees for Cabinet positions, and office seekers are glued to telephones calling for Executive Branch jobs. Amidst the tumult, President-elect Trump should soon consider another job that must be filled. It is less powerful than many cabinet positions, but often high profile. It deals not with bombs or buildings but with health and humanity. With Ebola just behind us, and who-knows-what disease disaster just ahead of us, this job is crucial. Donald Trump must select the next Surgeon General (SG) of the United States.

C. Everett Koop (1916-2013, SG 1982-1989) had recently retired as the Surgeon General when I graduated from the Loma Linda University School of Medicine in 1991. He was our commencement speaker, and his words shaped my thoughts as a young doctor. This article will review the job of Surgeon General, and consider some attributes that have made recent Surgeons General successful. Many have served as acting Surgeon General since the post tends to be low on Presidential appointment priority lists, but we will only consider the appointed office holders here.

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Health and the 2016 US Presidential Candidates

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How important is each candidate’s health in presidential elections? How do the candidates stack up?

By Mark D. Harris

The 2016 Presidential Campaign is nearing its end; in only two weeks American voters will decide who, most likely Hillary Clinton or Donald Trump, will sit in the Oval Office. The US presidency is a hard job, with grueling hours and the need to make critical decisions at any time, day or night. Campaigning for president is itself a tough physical endeavor, one that speaks loudly of the health of the candidates. This year has been especially bitter, with accusations and recriminations more appropriate to a college dorm than to the highest office in the land.

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How to Improve your Health and Health Care

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Most people get lost in the maze of health care, and suffer as a result. Some strategies help…

Throughout Central Asia, the Middle East, and much of the developing world, people have told me that they cannot get good medical care. In some cases good care is too expensive, in other cases medical care is affordable but poor quality, and in still other cases medical care, good or bad, does not exist. Some friends with significant health care problems labor in austere conditions never knowing when a medical emergency will strike, and if they will be able to get help when and where they need.

Some people have similar problems in the developed world, even including the United States. America has been swept by debates about health care, especially about how to make quality health care available to all Americans. Medicare is a government single payer program for the elderly and Medicaid is the same for the poor, but these programs pay providers too little and yet are unsustainably expensive for the nation. The Affordable Care Act (ACA) was the most recent Federal attempt to improve Americans’ health, but the results have been mixed. Fundamentally the ACA was health insurance reform, not health care reform, and providing someone with an insurance card is not the same as providing them with health care. Hence we have millions who lost their insurance, millions who got new insurance, and millions waving their new insurance cards in the air who cannot get care because it doesn’t exist in their area, wait times are too long, or the system pays so little that providers cannot afford to take these patients.

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Healing the Health Care Cost Conundrum

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A prescription for making US health care better quality, more accessible, and less expensive for all of us. 

The military health care system is different in many ways from the civilian system, but a primary difference is the income incentive. Simply put, health care providers and other medical professionals are not paid based on the number of patients that they see or the number of procedures that they do. Instead they receive a fixed salary with few if any bonuses for productivity or quality. The budgets for military health care institutions, and many others in the Federal government, are based on Congressional appropriations, not on productivity. This has been changing in the past decade but remains largely true today.

Civilian medicine is not so. They are paid for what they did, patients seen and procedures done, and everyone on staff is usually highly motivated to do more. Some have described such fee-for-service reimbursement arrangements as “you eat what you kill.” In some practices, that can equate to more visits and more procedures, even if some are not medically required.

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