How will the candidates fix American health care?

I don’t know. There was a pretty good piece in the New England Journal of Medicine, but it’s really not clear enough for most readers (including myself).

The McCain and Obama websites give fairly comprehensive looks at their health plans, but nothing useful for a lay reader.

The good news is that both campaigns have a plan. The bad news is that it is virtually impossible for anyone who cares to make heads or tails of the two and compare them effectively.

Well, gentle reader, I’m going to do you a favor. As an educated and knowledgeable professional, I am not going to try to parse through the various written statements, all of which leave me with more questions, in order to help you understand the issue.

I’ve left requests with both campaigns to ask to speak directly to other human beings, and if all goes well, to present to you an unbiased look at both plans and their implications.

Don’t hold your breath. Obama’s website has a pretty easy way to leave press inquiries. McCain’s not so much.

I just realized, I should probably outline a few problems.

First, in the U.S., we cost more and yet deliver worst outcomes than most industrialized nations. Second, we leave large numbers of the population uninsured.
Third, we compensate doctors based on physical procedures done to patients and don’t compensate for using thinking a research to answer a question to improve a patient’s health.
Fourth, our medical education is expensive.

So, graduating physicians have little incentive to take their debt-ridden bodies into a relatively lower paying primary care specialty and effectively force them into higher-paid, but less needed sub-specialties. We also create incentive for doctors to spend money by ordering tests and doing procedures, rather than by developing and following evidence-based guidelines.

The technology for electronic health records has been available for years, but for small practices such as my own, the cost is tremendous. EHRs improve patient care in innumerable ways, including tracking tests and other data, and improving communication with other providers and with patients.

That’s just a few things from a doctor’s perspective.