Many of my patients are concerned about healthcare. They are asking what physicians think about healthcare reform and what we are doing to effect change.

The answers are complex.  Physicians concur that major change in our healthcare system is needed, both from the standpoint of accessibility and that of escalating cost.  The American Medical Association recently voiced support of the Administration’s healthcare reform. While physicians support healthcare reform, many feel that the AMA has sold itself short with its support of the current proposals.  As a result, many physicians have elected to withdraw their membership or have chosen not to join this association.  Physicians, along with many other members of our society, who are concerned with what is happening and what is not happening with healthcare reform, are talking with our Congressmen.  There is a meeting on September 15, 2009 of the Medical Staffs of all three hospitals in Savannah – the main speaker at this meeting is a former Canadian Minister of Health. This should provide insight into Canada’s healthcare system. The more we know about the history of healthcare reform, the less likely we are to repeat the mistakes of others. I urge caution in moving towards healthcare reform too quickly. Healthcare reform is too important not to do everything we can to get it right the first time. In spite of the Administration’s promise not to increase the national debt with his plan, the current proposal will certainly increase the debt by hundreds of billions of dollars (or decrease the available healthcare), affecting not only this generation, but many generations to come. 

Whenever accessibility to something is an issue, the first thing that must be addressed is cost. What are the “big-ticket” items that contribute to cost? In the current debate over healthcare reform, something that is rarely discussed is the effect of our current legal system on the cost of healthcare. Many members of Congress are attorneys and are unwilling to pass laws that would significantly change our tort system.  As a result, many multimillion dollar lawsuit verdicts are continuing to be awarded. This adds billions of dollars to the cost of healthcare. Due to a concern over potential lawsuit, physicians practice defensive medicine which does not result in higher quality of healthcare. (As a side note, it has been proven over and over that high quality healthcare costs less.) As an example of defensive medicine, tens of thousands of unnecessary CT scans are ordered in emergency rooms every year on patients that present with a headache; this is done so the 1 in 10,000 patients who has significant disease that might be missed without the scan cannot sue because of a missed diagnosis. Our society has developed a “you owe me and give me” attitude that we all have to pay for.  Many years ago my wife and two small children were involved in an automobile accident in which an older lady ran a stop sign and ran into the side of our car. The children were unharmed, and my wife suffered a broken arm. Insurance covered care for my wife’s broken arm and repair of the car. The older lady’s insurance company hounded us for two years, asking that we sign an agreement not to sue in exchange for a $20,000 payment – we never signed the agreement nor received the $20,000. My wife and I did not want the “blood money;” my wife and children were fine, the car was fixed, and the woman who ran into them made an honest mistake. The $20,000 was apparently the “blue-book value” for a mother with a broken arm with two small children. As long as this “you owe me and give me” mentality prevails, we will not be able to control the cost of healthcare. These payments run up the cost of insurance for physicians and hospitals which in turn increases the cost of healthcare for everyone. Not only does our tort system raise the cost of physicians and hospitals, it raises the cost of supplies including drugs and equipment such new technology used in the operating room.  Effectively addressing tort reform would allow universal coverage, eliminate pre-existing conditions, and allow the practice of high quality medicine without “breaking the bank.”

Another major factor affecting healthcare cost is that of lifestyle. Some studies show that up to 70% of all disease process is affected by lifestyle. The individual who sits on a couch, eats in excess, does not exercise, drinks too much alcohol, and smokes cigarettes is at much higher risk for heart disease and cancer than the individual who has the opposite lifestyle. A healthcare system that promotes healthy lifestyle and preventative medicine reduces cost significantly. A local company, Intervent USA (subsequently purchased by Nationwide Insurance), demonstrated this conclusively.

In summary, we need healthcare reform! Let’s work together to do it right the first time. Please contact your Congressmen and let them know what you think.

In promotion of healthy lifestyles, I offer the following:

    In The Kitchen With Dr. B. – Summer Veggie Salad  

Heading towards fall, I could not resist posting this veggie dish which goes great with anything on the grill. The key is fresh ingredients cooked to just the right degree of doneness – this applies to most things I cook. If I cannot get good green beans (ones that do not have brown spots and tough skin), I buy haricot vert (the skinny French green beans) which are, many times, fresher than the regular green beans.

3 medium red (new) potatoes, peeled or unpeeled, cut into 1/2 inch cubes
1 tablespoon (or so) plain white vinegar
1 pound green beans, tough ends broken off
3/4 teaspoon Dijon mustard
1 tablespoon red wine vinegar
2 1/2 tablespoons extra virgin olive oil
Kosher salt and freshly ground pepper
1 teaspoon (or less) chopped fresh tarragon
1 teaspoon snipped chives (cut with kitchen scissors)
1/4 teaspoon chopped fresh thyme leaves
1/4 - 1/2 pound cherry tomatoes, halved

Put the potatoes in a large pot of salted water, and bring to boil. It is important to check for doneness as soon as the water comes to a boil.  The potato cubes should be a little undercooked so they do not fall apart when tossing them in the salad.  Drain the potatoes in a colander, put in a bowl, toss gently with the white vinegar, and let come to room temperature. (The potatoes will continue to cook until they reach room temperature.)

Bring a large pot of water to boil, add salt, and cook the green beans until they are “crispy-tender.”  The will take 5 minutes, plus or minus. If you are using fresh haricot vert, these may be done before the water boils. Drain and put in a bowl of cold water with ice to stop the cooking. When the beans are chilled, drain, and pat the beans dry. I use a clean dish towel for this. Whisk the red wine vinegar with the mustard in a large bowl. Gradually whisk in the olive oil and season with Kosher salt and pepper. Add the green beans and chopped herbs. Toss to coat the beans. Add the tomatoes and potato cubes, toss gently, and serve. If not serving immediately, the salad may stay covered in the refrigerator four hours.