AMA attacks are enough to make you sick

I had just come back from seeing Michael Moore’s new film “Sicko,” and all things considered, I was actually feeling pretty good. Then I read about how the American Medical Association is calling on the government to investigate the growth of retail health clinics. That’s when I started to feel sick.

Don’t get me wrong. While I like Michael Moore and appreciate his work, I don’t believe he is always right, nor am I naïve enough to believe that he doesn’t have an agenda. I’m not an idiot.

Actually, I think I am just smart enough to know when something is broken. I don’t need an MD or an MBA to tell you that there is something wrong with the U.S. healthcare system. To call our health system a “system” is a bit misleading; a system, by definition, is a complex group of interacting elements that come together to form a cohesive whole. Health care in this country is nothing like that. It is highly fractured to say the least.

Whatever you call it, the U.S. healthcare system ranks No. 37 in the world, just ahead of Slovenia (No. 38), but not quite so good as they have it in Costa Rica (No. 36). That’s not the Michael Moore camp that made up those statistics; those are the World Health Organization’s numbers.

We pay more for health care—twice as much—as any other country; last year total U.S. healthcare costs represented 16 percent of the nation’s gross domestic product, a little more than $2 trillion. It is expected to double over the next 10 years to more than $4 trillion, about 20 percent of our GDP by then. That’s not fuzzy, liberal math, either; that’s what a group of analysts at the Centers for Medicare & Medicaid Services came up with.

Then there are two other interesting crosscurrents out there that are helping to shape American health care and the way it is delivered in this country: between 1998 and 2005 the number of third-year medical students who chose to pursue a career in general internal medicine dropped by more than 50 percent; about 1-in-5 went into family practice; by contrast, the number of nurse practitioners in this country has risen from 30,000 in 1990 to more than 140,000 today.

That’s not Hollywood. That’s just the state of health care in America right now. It is a crisis premised upon access and affordability. And it’s not getting any better on its own.

I’m not so sure that universal health care is the answer. As many people that Michael Moore marches out of England, Canada or anywhere else that swear by the sanctity of their system, there is always somebody else over on the other side of the debate who will tell you about long wait-lists to get into hospitals in those countries: as many as a million people at any given time in the United Kingdom; 900,000 in Canada, they say.

I actually think there is something to this idea that the free market, when it is truly free to do so, can produce a viable solution to a crisis. That is the great promise of America; it is also the promise that is most frequently broken. Too often, this country allows the will of evil people to corrupt our free market for their own gain and to the detriment of the nation as a whole. Anybody remember the S&L scandals of the ‘80s? Too long ago? How about Enron or Worldcom?

While scandal may be too strong a word to describe the current state of health care in America, crisis most certainly is not. Still, we have seen it happen before in health care; we have all seen it happen in health care. Beware any time too many guys in blue suits get in between the guys with the white coats. It’s a classic tale of bureaucrats bullying providers, and sucking any penny they can out of the system along the way. Drug Store News has been writing about it for years.

Case in point: one-third of every dollar spent on health care in this country goes to administration fees and paperwork. PAPERWORK. Yet, the AMA wants to investigate retail-based health clinics, the most progressive solution to this crisis of access and affordability in American health care to come along in the last 40 years or more.

RediClinic president and chief executive officer Web Golinkin has had enough. “Much of the recent debate about how to reform our inefficient, $2 trillion healthcare system has revolved around who should pay, but the problem will not be fixed until we find ways to increase access and reduce costs that have been rising for many years at more than twice the rate of inflation,” Golinkin wrote in an Op-Ed piece in the Aug. 2 edition of The Wall Street Journal.

“One of the most promising developments is the emergence of retail-based ‘convenient care’ clinics,” he continued. “There are about [500] such clinics today and could be several thousand more in the next few years, but their growth is being threatened by burdensome regulations in some states and opposition from some corners of organized medicine.”

What’s even more curious: the sudden opposition from the physician community. Golinkin doesn’t get it either. RediClinic’s second biggest partner—after AOL founder Steve Case, that is— is Memorial Hermann, Houston’s largest hospital system.

And that’s not the only reason Golinkin is puzzled. “Although the medical community was suspicious of convenient care in the beginning, many physicians and professional organizations changed their view when they saw how rapidly consumers embraced the concept and how operators…treat many patients who do not have established physician relationships—an estimated 30 percent of all convenient care patients to date. The American Academy of Family Physicians, which represents more than 94,000 family practitioners, recognized that convenient care clinics were filling a need. Rather than opposing the clinics, it published standards of care that it suggested convenient care operators should follow.”

Those recommendations—almost to the letter—became the basis for the Convenient Care Association’s standards for care, which all of its members are required to meet.

So what’s changed since then? Well, the AMA has two problems with the clinics, it seems. On the one hand, some of its members are concerned about the quality of care that patients are receiving in the clinics. While laws vary from state to state, in general a nurse practitioner can treat about 70 percent of what a family physician can treat. They are treating a lot less than that in these retail clinics. This is about acute care. It’s not like anybody is doing heart surgery at the local corner drug store in these clinics.

Oh yeah, and the AMA also says it wants a level playing field with the clinics. You see, payers and managed care also believe that retail clinics are a pretty good answer to what’s ailing the American healthcare system; some health plans have actually begun to offer lower co-pays for clinic visits, and some are even waiving co-pays altogether, Drug Store News has learned.

I don’t know everything. But I am just smart enough to know when something is broken. The American healthcare system is in a state of crisis right now; better than Slovenia, but not quite as good as Costa Rica—aye, aye, aye! It’s enough to make you sick.