No medical screening should be offered unless the screening test has been shown to be adequately accurate, the disease to be screened for is important, and something meaningful can be done if the result is positive.
These first six articles require scientific data as to the effectiveness of interventions. Congress is crafting a "stimulus package" that includes more than $1 billion earmarked to generate such data, leading one to believe that the data that exists is inadequate to the task. That is misleading.
For more than a decade, there have been international efforts to define the evidentiary basis of medicine by analyzing the hundreds of thousands of randomized controlled trials on all sorts of interventions. This effort lends itself to the statements of efficacy that are called for in articles I through VI.
The stimulus package is stimulating a reinvention of the wheel that will effectively maintain the status quo in the United States for years to come. It is funding yet another impediment to informed medical decision making for patients.
Pricing of medical and surgical care should be transparent. Increasingly, American patients are asked to pay for their own care; even if they have health insurance, co-pays and deductibles are escalating. The assumption is that the insurance industry is passive in this trend, simply passing along the increased costliness of our evermore effective medical science. The country is being scammed. I have long been uncomfortable turning my consumer rights over to the insurance industry, but no patient should by willing to abandon those rights now that they pay so much out of pocket.
Articles I though VI demand effectiveness, Article VII is a demand for a statement of the "bang for the buck".
Why is it that for comparable drugs the price per pill in the United States is 50 percent higher than in European Union countries? Why is it that by 2006 we were spending about $450 per capita to administer our system when no other country came close to that amount? France got away with $250 per capita, Canada $150 per capita and Denmark, Finland and South Korea were under $100 per capita.
How is it justified that a hospital-based bureaucrat's salary can be many times greater than the that of the secretary of Health and Human Services or the governor? Why do specialists earn so much more in the United States than anywhere else, even though there is no evidence they are more proficient?
Why do we think that layers of regulations and tiers of committees and bureaucracies will guarantee professionalism more than peer review and openness?
Now that Americans are paying out-of-pocket, a free market means they should be able to comparison shop. It may be much more cost-effective to fly to Toronto or London or Singapore for care than to support American health-care price gouging.
There are more tenets, more of my legacy for my patients. But I am saddened that I need to leave such a legacy. It speaks to the fashion in which my profession has been co-opted by a health care industry that considers self-service to be a form of public service.
The fact that I as physician and you as patient must advocate for these articles is a reproach to our national ethic. If it wasn't for entrenched interests vested in the status quo, rational reform would be rapidly forthcoming.