Health Care Reform: Thoughts From a Radiologist to Be Ignored

“If anyone was to ask for my opinion, which I note they’re not ….”

Notwithstanding that statement, Gimli ultimately got his way. For those of you who haven’t read/watched The Fellowship of the Ring a sufficient number of times to know what the heck I am referencing, congratulations. You didn’t waste as much of your time as some of us.

Gimli might retort that he only got his way after all other options were exhausted. Perhaps that is what it will take to see a typical physician’s thoughts on health care reform put into action. It has stepped up from the usual bottom-rung talking point of “something should really be done about this” to “we’re going to do something about this.” Today, I even heard some high-ranking politico claim he had a plan. Of course, no details were offered.

Some would say that is because he had no plan. I am not quite cynical enough to assume that. However, I do have enough cynicism to know that if he did offer any details, they would immediately be picked apart and vehemently opposed long before a plan was fully formed and ready for proper consideration. One’s best chance at making that happen is keeping ideas hidden until they are fully cooked a la Nancy P: “We have to pass the bill so that you find out what is in it.”

The unfortunate thing is that health care, like many other things in the sociopolitical sphere, has long since become something about which we just can’t have a meaningful conversation. Suppose, for instance, you say that elective service X maybe shouldn’t be routinely provided to everyone who wants it and paid for with OPM (other people’s money). You will swiftly be decried as a Grinch who wants to take everyone’s health care away and see “people dying in the streets.”

Physicians, in particular, aren’t allowed to say much, which is kind of funny since folks on both sides of the issue take turns insisting that health care should be between patients and their doctors. If we do pipe up, often the immediate assumption is that we are just looking to line our pockets, bulletproof ourselves against accountability, and other selfish, if not nefarious, purposes.

By the way, that isn’t just the doing of non-physicians. Turf wars and feuds over division of the reimbursement pie between docs of differing specialties create plenty of noise to obscure whatever common aims we might otherwise wish to project. Nurses and PAs who want to expand their scope of practice add to the scrum.

When our motivations aren’t disparaged, we are virtually patted on the heads as naive nerds who don’t understand economics and thus can’t be trusted to know what is wrong with the health care system nor how to fix it. There is a grain of truth to this. A podcaster I like would call the current system a confuse-opoly. In other word, it has been made so grotesquely huge and byzantine that few people could ever understand it all, much less figure out how to fix it.

Nibbling around its edges might allow short-term improvement but the nature of the beast is such that it will sooner or later grow back as ugly as it is now if not worse. Ultimately, I think the whole thing needs to be replaced by something that is smartly designed from the ground up.

I have some ideas about how things might be done better and so, I would wager, do the vast majority of physicians who have spent any time working in the current system. Rather than counting on a select few to theoretically speak for all of us, I see no reason why everybody with, say, a minimum of five years’ post-training clinical experience, shouldn’t have input. Perhaps retirees who won’t be working in the new system should also be exempt.

It could begin with something as simple as each doc submitting a list of up to five points of personal interest to a national brainstorming pool. With over a million physicians in the field, that might sound like an overwhelming volume to read through. However, I suspect a lot of docs wouldn’t write five (if bothering with the exercise at all). Secondly, we are all working in the same dysfunctional system. I bet you anything that many of the submissions would echo each other.

On top of that, if you put a couple of AI agents on the task, they would make swift work of condensing the submissions. That is, if 300k docs wrote about a need for tort reform, AI could combine all of that into one item: 299,999 submissions never need to be read by human eyes. All said and done, there might only be a few dozen items on the list. They wouldn’t address everything, but they would get the most important stuff.

It would, after a fashion, be reminiscent of a Continental Congress, following our declaration of independence from a health-care system that all too often fails to get the job done, and hemorrhages huge excesses of resources in the process.

The next step, writing up something like a Health Care Constitution, would of necessity be done by a much smaller pool of individuals, hopefully still involving a good cross-section of practicing physicians (including radiologists) along the way. Even if we got sidelined at that point, though, it would be awfully hard for the HCC’s “framers” to ignore any of the major takeaways from the brainstorming step, whose results would be a matter of public record:

“Mr. Secretary, 30 percent of practicing physicians in the country listed Issue X as a fundamental issue with health care yet your plan doesn’t seem to address it. How do you intend to rectify that?”