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Health Care Reform: So Far, Not Much of a Debate

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DuboisRN_post.jpgThe problem with the current debate about health care reform is that it's no longer a debate, but has instead disintegrated into a free-for-all. All sides have become so frenetic about protecting their own interests and hurling politically based accusations that reasonable and reasoned discourse has been lost in the melee.

We're treating health care reform as if it were "The Blob" from the old sci-fi B-movie, terrifying citizens as it destroys everything in its path. Health care reform isn't a monster and could be a godsend -- a crucial improvement to a medical system that's one of the best in the world, but one that has become too unwieldy and expensive. Improving our health care system will aid many people who aren't receiving the standard of medical care they deserve as American citizens.

So, let's step back, calm down and refocus. At M. D. Anderson, we see the sickest patients with the worst prognoses.

Ensure availability of best treatments
1) We'd like to be sure that all of our patients receive the best treatments available, if they choose to be treated. Our policy isn't to give up on our patients. We have witnessed many instances where patients were told they had no options, only to be treated at our medical center or to be enrolled in a clinical trial and respond to treatment. In a few cases, these patients were completely cured. In many cases, their lives were prolonged for years. And in innumerable cases, their lives were prolonged for several months to a year. The vast majority of families we work with say that they appreciate the extra time their loved ones were given, and their out-of-pocket costs were worth their extra days together.

As a result, the health care debate must revisit the issue of reasonable costs for a family with a seriously ill loved one. Guidelines need to be established for treating these patients appropriately, without crossing the line with unneeded tests or treatments that will have no impact on their outcome. Legislators should also factor in what's learned in academic medical center clinics -- that scientists and physicians track patient responses and return to their labs and clinics to improve their medications and refine their protocols. Our health care reform package must be flexible enough to allow for growth in knowledge and encourage strong support of biomedical research.

Establish a set of measures
2) A new health care plan must include a set of metrics that can measure the success or failure of its component parts. This means that the health care reformers must decide now what it is they're aiming to improve. If "reform" simply means "cost cutting," then the task will be fairly simple and the debate will center around "how much to cut." If the reform includes improving the clinical outcomes of patients cared for in the United States, then a completely different and much more intricate set of measures will need to be evaluated.

We must have a full understanding of the costs and benefits of different treatment options. We must also evaluate prevention measures and whether patients who smoke, overeat and avoid screening procedures should be penalized by the system, or whether patients who don't smoke and lead healthy lifestyles should be rewarded instead. In other words, reform might mean placing a "value" on different health care options or a relative "value" on different treatment options. On the other hand, through the very exercise of creating measures, we'll begin to see areas where we can truly cut costs and other areas where we must maintain a certain standard of care.

Make room for science, discovery
3) It's crucial that any measure of reform provide an opportunity for new science and discovery. There are many hospitals in this country that are focused more on research and academic endeavors. We must ensure that the health care reform agreed upon doesn't do away with the academic/research segment of our health care system.

Fifty years ago, childhood leukemia (ALL) was essentially a death sentence with only a 4% survival. Today, it's one of the most curable cancers in our armamentarium (75-80% survival) thanks to the devotion of generations of scientists and physicians who wouldn't give up. Funding this research wasn't cheap and it took a lot of faith before breakthroughs began to emerge. But today, what parent who has a child being treated for ALL wouldn't say those resources weren't well spent? What active, productive, happy adult who was cured of ALL would say the benefits to society weren't worth the costs?

In other words, we cannot lose sight of our goals in this stewing cauldron of arguments about American health care. We shouldn't become sidetracked or weary because the noise is so loud and the confusion so disheartening. We shouldn't be afraid of change. We shouldn't stymie progress just because we can't foresee the future.

By the same token, we will have to regain control of the issue. That means calming down, listening to all sides, making reasonable decisions, building in measurements for outcomes, and reconnoitering when the results are less than excellent. We will only succeed through acts of bravery, determination and compassion.

I believe that Americans are up to that task.

1 Comment

Health Care Reform has really been a debate for quite some time. Hope the American people gets how they deserved to be treated and the benefits that they can get with this reform.

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