The problems of medical care in the United States

As the question of what to do about Obamacare heats up we're going to hear a lot about medical care in our country. I'm going to do a few posts on the subject. As usual I have some controversial opinions but I can't be accused of being uninformed since I know the system well from the inside and from many aspects. Early in my career I spent almost 10 years working in a county clinic in California, seeing indigent patients. Then there were 36 years in solo private practice. Along the way there were stints as a doctor in the army and in the VA system. I even was Scranton's city doctor for a year or two. At present I'm spending some time in the free clinic at the U of S seeing "undocumented" patients. 

I received my training in the pre-Medicare days and observed the transition to the program between my internship and first year of residency. So I've witnessed the full extent of the slow and steady impact of government invasion of our medical care.

The critics of our system say that we're spending twice as much on medical care as the other advanced countries but not getting as much in return. I disagree with the assessment of what we're getting but you'll get no argument from me about the present state of medical care in our country. Medical prices are way too high generally and the way they impact different segments of the population is totally irrational. Medical care delivery has become ridiculously complex and is restrained by our system from serving the public efficiently. 

Some say that the solution is to let the government take over. That is a bizarre idea. To paraphrase the sainted Ronald Reagan, the government is not the solution to the problem, it is the problem. Most people don't realize that government at one level or another already pays for 65% of medical care in our country as opposed to 75% in Canada. Government control is not a way to save money or improve efficiency. 

In the last few years we have been watching the dismantling of small independent medical practice at an accelerating rate. It is now down in the 35% range. Solo medical practitioners are almost a thing of the past. One recent commentary by a health care planner points to the natural trend toward consolidation in other areas of our economy. But what's going on in medicine is not a natural phenomenon. It is rather the result of a grand experiment by the federal agency that controls medical care in our country, the CMS. And it is a tragedy, not so much for doctors, who will get along, but for patient care. I read an article recently encouraging doctors to face their computer screen toward the patient and glance over the top occasionally to maintain eye contact. How pathetic!