Fake News: Toward a simpler healthcare reform

Concerns over the level of detail laid out in the 2,000-page health care reform package now before the Senate have prompted some to sketch out a simpler plan for keeping Americans well.

One proposal gaining in popularity would require doctors to keep records of their casual conversations outside the office and count these as delivery of medical services to millions of the nation’s uninsured.

“When a general practitioner runs into his neighbor at the store and asks ‘how are you?’, this should be considered a consultation,” said Ken Reddling of the National Insurance Institute. “If the neighbor responds ‘fine,’ the doctor would make a note that he’s had a patient encounter and that the patient checks out as healthy.”

Doctors could also record queries such as “how’s it going?’ and “you doing alright?” as similar meetings with positive outcomes, as long as the respondent answered that they were “great,” “pretty good” or “not bad.” Physicians practicing in the specialties could also include “how’s it hanging?” as a formal exam.

To reach even greater numbers of those needing health care, another plan would erect pedestals at major intersections throughout a city that were topped by a large Plexiglas box. Sealed inside the container would be an internist or family practitioner, dressed in a white lab coat and wearing a stethoscope around his or her neck. Passers-by would then “see the doctor” as they drove past, which would count as a formal visit, even though the encounter might be slightly longer than what the patient would experience in a clinical setting.

“We need to be creative in the ways that we deliver care to the public,” said Reddling. “The Hippocratic Oath calls on doctors to ‘first do no harm.’ We can at least do that much at a minimal cost to the taxpayers.”

Meanwhile, recent studies showing that many preventive tests are neither medically necessary nor cost-effective may result in a different type of screening. Previously routine exams to detect breast cancer, prostate disorders and cervical disease have been increasing anxiety and expenses without a corresponding improvement in long-term outcomes. Some are now suggesting a more casual “quiz” replace the formal tests.

“These don’t have to be complicated. We’re not talking about essay questions but rather simple true/false or, at most, multiple-choice queries,” said Maurice Lerner of the Council for Approximation. “You phrase questions like ‘my head really, really, really hurts — true or false?’ and if they answer false, you’ve determined that they don’t have brain cancer.”

More complicated conditions would merit a more detailed inquiry. Even mental health could conceivably be covered with a well-structured, carefully phrased question.

“You ask the patient to answer the following: ‘I feel like committing (a) a personal foul, (b) my PIN number to memory, (c) a faux pas, or (d) suicide,'” Lerner proposed. “Only if they answer (d) would any follow-up be necessary.”

Initiatives like those mentioned above are already causing senators currently debating reform to hesitate final passage of a bill until all available data is in. Scientific studies in many of these areas may be considered complete enough to set public policy that provides the most good for the most people at the most economical price. But even advocates of unbiased analysis admit that all the anecdotal evidence has yet to be considered.

“I think we need to delay this bill until we’ve heard everybody’s story,” said Sen. Jim DeMint of South Carolina. “There are millions of aunts and uncles, and literally tens of millions of guys who knew other guys who wouldn’t be alive today were it not for some obscure procedure of highly questionable benefit. Numbers from long-term studies only tell part of the story. We need more anecdotes.”


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One Response to “Fake News: Toward a simpler healthcare reform”

  1. fakename2 Says:

    These are great suggestions. I have another, courtesy of the clinic I go to. I actually have a primary care physician there, but I will be dead or cured by the time I can get an appointment with him, so I usually have to go the walk-in route. So I went one day and said, “I’m having trouble hearing, and also, my stomach hurts.”
    “Look”, said the nurse, “We consider ourselves an urgent care facility. You gotta pick one problem or the other.” See the beauty of this? One of my problems was solved instantly, at no expense to my insurance company. Think of how much we could save on people who were, say, having a stroke and a heart attack at the same time.

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