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Thursday, January 22, 2009

Without the routine cruelty: A path to health insurance for all

From Dr. Atul Gawande's essay in the New Yorker:
I once took care of a 19-year-old college student who had maxed out her insurance coverage. She had a treatable but metastatic cancer. But neither she nor her parents could afford the radiation therapy that she required. I made calls to find state programs, charities – anything that could help her – to no avail. She put off the treatment for almost a year because she didn't want to force her parents to take out a second mortgage on their home. But eventually they had to choose between their daughter and their life's savings.

For the past year, since universal health coverage in Massachusetts, I haven't had a single Massachusetts patient who has had to ask how much the necessary tests will cost; not one who has told me he needed to put off his cancer operation until he found a job that provided insurance coverage. And that's a remarkable change: a glimpse of American health care without the routine cruelty.

Dr. Gawande mentions this patient, and the Massachusetts model of health care for all, in the context of describing how governments have generally brought about universal coverage by expanding existing programs rather than starting completely afresh. He raises the possibility of achieving universal coverage by expanding Medicare, or the Veterans Health Administration's system, or Federal employees' insurance plan, etc.

The veterans' health system offers the best starting place, for it provides what is demonstrably the highest quality of care in our country. We should expand the VHA to offer universal care for four key reasons. First, its care for patients’ chronic illnesses is exceptional. Second, it offers care across the country, in a network of 170 hospitals. Third, it uses an integrated electronic medical record, so when patients move across the country, or have medical needs while on vacation, their medical records can easily remain accessible by nearby doctors. Fourth, it is primarily a provider network, rather than a virtual insurance network, which gives it more intrinsic capability to further improve the quality of care.

We should allow the VHA to recruit more physicians so we can offer uninsured people who live near VHA hospitals the option of getting their care through the VHA.

Read a very different story from Dr. Gawande.

Thanks to Dr. Atul Gawande for the source article in the Jan. 26 issue of the New Yorker.

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