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Monday, October 5, 2009

Discussing Healthcare - Who Do You Listen To??

Before I post a "how to" on the reading of your insurance statements and doctor and hospital bills, I can't help but to give my two cents on what is passing for thoughtful debate on the health care issues today, avenues of reform, and what it might look like after reform. I recently attended a lecture by journalist and author Shannon Brownlee titled "After Reform: How We Can Transform Medicine, Improve the Nation's Health, and Avoid Going Broke." Brownlee has written extensively on this subject which apparently makes her an expert. And this is my point...Why and how are journalists, politicians, health care policy guru's, health insurance companies considered the "experts" on our health care? How is it that their generalizations, which are applied broadly across the spectrum of the issue, are embraced as the 'truth' about whatever agenda they happen to be championing? For example: Are we talking about the delivery system of health care? Are we talking about how to pay for the actual medical care? Are we talking about improving how doctor's make decisions? I had hoped to get some answers to some of these questions at a lecture rather than a press conference, and it was still not presented with any clarity. All of these journalists, media and print, and politicians do not acknowledge the following about our health care system:

There are three major types of health care "delivery systems":

1) The VA hospital system (Veteran's Administration);
2) The Academic hospital system (i.e. UVA in Charlottesville, Virginia, or Georgetown University in Washington, DC) These are teaching facilities, and can be either public (UVA) or private (Georgetown);
3) Private hospital systems.

Our private hospital systems are also distinguished by profit or not for profit, and have a variety of models on which they base themselves operationally.

Private practice doctors are not employed doctors. They are not "owned" by a corporation or the government. This has both advantages and disadvantages. Each of the models above have problems inherent to their particular system. To talk about the problems of our delivery systems without distinguishing from their particular system under a global umbrella is misleading.

Tomorrow....our system of paying for healthcare.

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