Tuesday, August 25, 2009
Always take the history!
I stress to my students and residents that the key to diagnosis and treatment is taking the patient's history. I then have then research what is known about the disease state and tell me what treatment options have been tried and what seems to work. I am glad that none of them are politicians as our elected officials seem to want to ignore the history. I started looking at Massachusetts attempt at mandidate insurance and found that the costs are skyrocketing, access is lower and overall it is collapsing. Even better, I found Tenncare. This was the implementation of Hillary Clintons health plan in Tennessee. It was a massive government public option that was designed to be a to compete with private insurance in the state. So what happened? First, the cost tripled and the state went bankrupted. Second, it reimbursed so low that hospitals closed and refused to see patients with the government option. It got so bad, that the state did not pay some hospitals for over 3 years. Since the Tenncare paid less than what it cost to provide care and the cost was to be made up by the privare insurance companies, they left the state. Lastly, because it was given for free, people from other states flocked to Tennessee to get free drugs and care. So in a nut shell, Tenncare bankrupted the state, decreased access and care to patients and disrupted the whole healthcare system. Now, Obama and his team want to institute Tenncare to the whole nation. What did Tennessee do? It went back to a Medicaid form of governmental medical assistance and encouraged private medical insurance providers to come into the state. It made sure that it kept taxes low to bring in industry and business and enacted tort reforms.