The Health Care Conundrum


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expert perspective telescopeExpert Perspective from Grahall’s Michael Graham and Arlene Brewster

A July 23, 2009 article on quotes President Obama: “Speaking about the benefits of his plan, [Obama] said: ‘it would offer security and stability to sick and healthy Americans.…the debate is about people lacking health insurance because they can’t afford rising costs, get denied due to a pre-existing condition, or lose their jobs… This debate is not a game for these Americans, and they cannot afford to wait for reform any longer’…”

Grahall’s Michael Graham agrees that health care reform must address cost and focus on prevention.  Further, Graham says:
1) An ounce of prevention is worth a pound of cure. In fact the value of prevention versus treatment is probably 16 to 1. Just as $5 dollars of engine oil can save $80 of repairs later on,  $500 in preventative care could save $8,000 in medical costs.
2) The incentives are perverse. A doctor or hospital gets paid more money if a patient’s illness is more severe and requires more tests and treatments that extend the patient’s stay.  The doctor is incented to order tests and procedures that are not really needed, but not adequately incented to provide preventative care.

Graham concludes by saying: “Our great and greedy society might benefit from a dose of socialism. Medical care might be the right place to start.”  In fact, as one of Michael’s favorite clients once said: “The future is easy to predict, it is happening today. All you have to do is open your eyes to see where the future is.”   Graham adds: “If I were applying that wisdom to the healthcare debate I’d say there is a multitude of healthcare “experiments” going on today in other countries.  Only a bunch of fools would not study other countries’ approaches to health care for their citizens. If we redirected 1 percent of our budget for war-related efforts towards investigating and identifying the country with the optimal solution for healthcare and then implemented that solution here in the U.S., we could save far more lives than are currently threatened by terrorists. Far more people die annually in the U.S. from lack of access to healthcare treatment than died in the 9/11 tragedy.  

Grahall’s Arlene Brewster Ph.D. weighs in with some key observations that contrast to Graham’s.  Brewster says:  “I do not believe that physicians desire to see patients become sicker. Those physicians with whom I have worked become very frustrated when they cannot help a patient get better.  But when a patient comes in with an illness or diagnosis, the incentive to over-treat is very great. It is not only because procedures pay more. The perverseness of our litigious society requires that physicians practice “defensive medicine” in order not to get sued. 

Brewster’s list of next steps follows:

1) We need more primary care physicians and will only get them when compensation for this important job (when compared with other medical specialties) increases.
2) We need a “best practices” model of care rather than a procedurally based model of care. There is much information about the best way to treat a diagnosis. Physicians should be rewarded for that, and not for ordering more procedures.  
3) Set rate payments need to be structured for handling patients, rather than doing procedures.
4) We need to have lawsuits arbitrated, so that frivolous ones do not go to court.
5) We need to fairly reimburse for cognitive, not just procedural, medicine.  For example, my son in law, who is a neurologist, spent an hour and a half talking to a patient who had been diagnosed with a terrible, terminal neurological illness. My son in law received no reimbursement for that time.   Who could possibly argue that that is not important for a doctor to spend that time with a patient?   And then shouldn’t the doctor be compensated for that time as well?

It is difficult to “rally the troops” to solve this enormous problem in a politically, economically and culturally diverse a country as ours.   Even the Democrats can’t agree among themselves.  In an article for Reuters published on August 1, 2009, titled “Analysis: Democratic Groups Defied Obama on Healthcare”  Matthew Bigg says: “[Making up] .. about a fifth of the Democratic majority in the U.S. House of Representatives, … [a group of conservative Democrats dubbed the Blue Dogs] has trimmed the cost and scope of Obama’s [health care reform] effort, whose main aim is to provide medical coverage to many of the 46 million uninsured Americans. … Those Blue Dogs, along with new recruits elected last year, have walked a fiscally conservative line in Washington, a strategy that analysts say appeals to constituents, especially in Southern states, which oppose heavy spending or tax hikes…. But outright opposition to healthcare reform creates problems for Blue Dogs in districts with large numbers of African-Americans, who are the most reliable Democratic voters and generally support policies that address social inequality.”

We hope that the dogs of all colors (and the cats as well) will heed to advice of Graham and Brewster and get on with fixing the problem.

Email Michael Graham at and Dr. Arlene Brewster at

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