How Bad Is It? We’re not sure, but we know it’s bad.

Personal and heated, debates over the American healthcare system have been raging all over the country, making healthcare one of the US’s most pressing domestic issues. To address this issue, several Hamilton alumni from the class of 1970 comprised a panel in the Alumni College series during this year’s reunion. Each of the three alumni has made their career in different aspects of the medical system. Thomas Biancaniello has worked for many years as a pediatric cardiologist and has published and taught extensively in his field, Mark Kahn is a vascular surgeon who is associated with Mount Sinai NYC, and Donald Stangler is an internist and rheumatologist with his own practice in Connecticut, although he has worked at Oxford Health Plans and UnitedHealthcare in France as well.

The panelists began by describing the myriad components of the healthcare system in America that makes it so complicated. Physicians primarily seek to avoid liability; one lawsuit can end a doctor’s career. Physicians want a good job but conditions often work against them and, instead of serving each patient to the best of his or her ability, doctors find themselves able to give less and less time to each patient and passing patients to other doctors for fear of liability. Businesses struggle to cover the healthcare costs of their employees. Hospitals feel constant pressure to expand, and as the cost of medical technology keeps rising, a steady cash flow is hard to find. HMOs are cutting deals with hospitals and putting them in competition with one another, and hospitals subsist on grants and charitable donations instead of money from insurance companies and the government.

 The insurance companies and HMOs arguably have the most control, seeking profit both through hospitals and doctors. And, in the end, it’s the public that suffers; hospital costs are out of reach for almost all Americans and while insurance costs are often manageable, the quality of care and lack of freedom to choose one’s own doctor leaves many Americans dissatisfied and in financial straits from a lack of insurance coverage. The populations of the poor and the elderly are growing, and the current system is already struggling to care for them. In addition, the nursing home system is completely unmonitored by any governmental agency, resulting in some questionable practices.

It is these conflicting interests that Dr. Biancaniello described as a “lack of alignment”—that is, that the cost of healthcare does not match up to its performance. Healthcare in the United States is some of the most expensive in the world, yet we were ranked a staggering 37th by the World Health Organization in 2000. And the costs continue to soar; over a third of healthcare costs are for tests that are unnecessary, but doctors continue to request these tests because they want to confirm their diagnoses, compounded by their fear of liability. But doctors have no incentive to cut down on these tests, costing billions of unnecessary dollars. “Last year $2.5 trillion was spent on healthcare, next year it will be $4.5 trillion. No one can pay for it,” Dr. Stangler said. “You can look at it any way you want, but everyone has a part that is causing it not to work.”

American healthcare also fails in its lack of accessibility. 35-50 million people are uninsured or under-insured. As a result, visits to the emergency room are also problematic; 40 percent of these are for primary care, not the facility’s intended purpose. Visits typically cost $1,500 each, paid by the federal government—and thus, taxpayers. But the most significant failure, as all three panelists mentioned, is the lack of focus on preventative care. Insurance companies do not reimburse for preventative care, despite the fact that a few hundred dollars spent in this way could save thousands per person in the future. And as childhood obesity becomes an epidemic, preventative care could be pivotal for the lives of millions of people, not to mention a relieved burden in the future for the healthcare system.

In the end, the panelists were split as far the functionality of the current healthcare system. Dr. Kahn thought that the system is inherently flawed and needs to be scrapped; Dr. Biancaniello and Dr. Stangler were more optimistic, having confidence that the system can work, albeit with some reform. Either way, continued lobbies on congress and public dissatisfaction make reforms inevitable; the extent of that reform will be a continued topic of debate among healthcare professionals for years to come.

by: Alexandra Ossola '10

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