Mark Twain once observed that while everyone talks about the weather, nobody does anything about it. The same might be said about reforming the health care system in the United States. That could soon change, however, with a new administration in Washington, DC. President Barack Obama campaigned on the promise of reforming health care and appears to have the support of the public and Congress to enact reform. But what should be done and what reforms are most needed? North Dakota Medicine asked four health care professionals with different perspectives for their thoughts.
What are the major issues facing the U.S. health care system?
Dwelle: We have an increasing population of uninsured individuals. Because of that they’re either going without curative care or are maintaining a large debt because of the costs. We need to have an overhaul of our whole system. Do we need a national insurance plan? Is there a way of staying within the private insurance system? How do we deal with the poor? I’m not sure there’s one clear path or one answer, but they need to be addressed.
Wakefield: There are three major challenges. The first is the rising cost of health care. We’re paying a
lot of money for health care in this country – over $2 trillion last year – and we’re far from getting consistent value for thatexpenditure.
The second major challenge is access to health care services for the uninsured. That’s not as big a problem in North Dakota as it is in other parts of the United States but for every individual without insurance, there are financial repercussions not only for that person but also for the health care system where they seek care.
The third issue is variability in health care quality and patient safety. That variability is across the country, it’s across North Dakota and it’s even variable within health care systems, shift to shift and day to day. You can’t assume that whether you’re in the largest or the smallest health care delivery system in the United States that on any given day on any given shift in any given unit that all of the health care you receive will be consistently safe and high quality.
DeLorme: The big issue is this super-monstrous national debt, combined with the elimination of under-represented minority health profession training programs at medical schools across this country. That’s not on the horizon, it’s already here. What’s that going to mean for rural health care delivery? What’s that going to mean for delivery of health care in Indian Country when the reality is that there aren’t the medically trained people to go out and fill the positions in our tribal communities? I look at the reality and say that we’re headed for a personnel crisis in health care delivery in Indian country.
Beattie: The challenge of health care is: how do we continue to do what we do, better? As much as economics shouldn’t be a part of health care, they’re a reality. As a family physician, having lived in rural America and taking care of people on a first-name basis for a long time, what somebody can pay or who’s paying for them is less important than what they need and how we provide it for them. Unfortunately, there comes a point where the fiscal realities of what we do can’t be ignored. We have to be prudent to provide the mission of taking care of everybody. That’s the constant struggle for rural America.
Our health care experts
Robert Beattie, MD ‘89 (FP Res ‘92), chairs the Department of Family and Community Medicine at the UND School of Medicine and Health Sciences.
Eugene DeLorme, JD, is director of Indians into Medicine (INMED), a comprehensive education program assisting American Indian students preparing for health careers.
Terry Dwelle, MD, has been the North Dakota State Health Officer since 2001. He has worked with the UND School of Medicine and Health Sciences, the U.S. Centers for Disease Control and Prevention, and the Indian Health Service.
Mary Wakefield, PhD, RN, FAAN, is associate dean for rural health and director of the Center for Rural Health at the UND medical school. She has expertise in quality and patient safety, rural health care, Medicare payment policy, workforce issues, and the public policy process.
