Commentary: An Old Doctor’s Take On The Health Care Dilemma

By Dr. Walter Lawrence Jr.

I believe our national health care program sorely is in need of further change. The currently increasing COVID-19 problems temporarily have shifted our attention away from this need, and for good reason.

But the pandemic actually has further impacted this national problem. Since I directly have been involved in health care as a physician since the 1940s, and in many venues ranging from private office practice to large hospital systems, I'd like to share both my observations and my recommendations.

Ever since the years right after World War II, the U.S. has been the world leader in both the basic and clinical research that has revolutionized health care both here and throughout the world. However, along with most Americans, I believe we need a significant change in our health care system to profit from this.

We do want to assure inclusion of everyone as recipients, but the main goal now needs to be finding a solution to the escalating costs. They exceed those of all other developed nations despite their generally better health care outcome statistics than our own. Some of these current problems were addressed by the Affordable Care Act (ACA, also known as Obamacare) that, in fact, has ameliorated the incomplete coverage of some citizens.

But it did not solve the problem of excessive costs that continues to plague us. How is the U.S. so different than these other nations and how can we alter things to correct our problem?

It is my belief, and that of many others, that it is the unrecognized change in our philosophy of health care from that of being a service for all of our citizens-like a safe environment and safe water, and police and fire protection-to that of being a vigorous and highly profitable "industry" providing these services.

When I became a physician in the 1940s, health care merely was a nonprofitable service but was one flawed by two levels of care. One was for those who could pay what then were modest charges and the other a "charity service" that often provided a lower-quality care. Over time, patient-purchased health insurance appeared and expanded the number of people receiving the higher level of care.

This group further was enlarged by the appearance of employer-based health care insurance as part of the worker's compensation, which certainly was paid for by deductions from paychecks.

As the above changes in remuneration for health care were taking place, along with quality-of-care improvements for those who were covered by insurance, these advances partially were offset by the escalating costs that I referred to above.

These were from the many components of the system providing care that gradually shifted it purely from a service to a very profitable industry lacking some of the "controls" of our free market system. This led to overcharging for many of the required "goods and services" (pharmaceuticals, supplies and equipment hospital services of all sorts and, yes, some physician charges as well).

This escalating cost problem was the major change that led to the deliberations prior to the ACA. This legislation has been beneficial in some ways, such as increasing the population covered, but has done very little in regard to this escalating cost problem here in the U.S.

All other developed nations have avoided this escalating cost problem we are saddled with for one main reason. They generally have adopted some form of a "single payer" system capable of "negotiating" overcharges of various sorts-a process our multiple insurance plan, meanwhile, is unable to accomplish while still adding much more administrative cost to the whole process.

Arguments made against this single-payer approach have been that it is more expensive for our government and our populace, and requires complete government control. But these are myths and clearly are not the case.

Now, instead of rejecting Obamacare, as was the focus of the retiring administration, my hope is that our incoming administration can introduce legislation to modify the ACA along the lines outlined here. Doing so would be both a boon and a bargain by replacing what is a profit-driven industry with a valuable service for all our citizens.

Walter Lawrence Jr., M.D., is a retired surgeon who is a professor emeritus from Virginia Commonwealth University and a consultant to the McGuire Veterans Affairs Medical Center.