Category: American Healthcare Blog

Amy Lee is a thirty-three year old ER physician who left her island home after the drowning death of a close friend following high school graduation. Now, fifteen years later, she returns to find her father suffering from a life-threatening heart attack.

While visiting the island, she also discovers the body of her high school friend, floating in the ocean, whom she thought had died. Worse still, her brother has been arrested for his murder. Promising to find the real killer, she embarks on an investigation.

Hampering her efforts to find him, are her father’s deteriorating health, her emerging attraction for her father’s doctor, the efforts of the Chief of Police to rekindle their high school romance and the number of island residents who might have wanted her friend dead.

As the case against each of the suspects begins to break down, Amy is left with the emerging suspicion that one of her former friends might actually be the murderer. And the closer she gets to the truth, the more she finds her own life in danger.

A Wave of Change is a cozy mystery which introduces a new heroine, Amy Lee to readers. She has been described as a strong, independent woman who has never lost her love for her native island but who struggles to balance her professional life with her desire to have a family.

BOUNCEBACK is a medical mystery/thriller about a recently retired physician, Henry Stevens MD, who finds himself  unprepared for life after medicine.  That is, until he receives a fateful telephone call that his little sister has been involved in a serious motor vehicle accident.  He promises to guide her through the medical labyrinth of her recovery, only to find her suddenly, inexplicably, dying while in rehabilitation.

When he tries to learn what has happened, he is stonewalled, which leads him into a dangerous investigation, which begins with suspicion, progresses to include several “accidental” deaths and eventually leads to a conspiracy which could endanger the lives of many more, including his own.

This represents the origin story for Henry and is the first in a series of novels about his adventures.  This book is currently available on Amazon.com and as an e-book on Kindle.

Two subsequent novels, ROGUE MD and THE NIGHTHAWK PROTOCOLS are already available on Amazon. com.

“detailed characters and a scarily believable world for them….if you’re looking for a book to read check out these medical thrillers”  E.K.

A pipe dream? Perhaps. It requires people to do what’s best for its citizenship, not just what is best for themselves. And it requires some serious, outside-the-box thinking.

Let’s deal first with physician care, something near and dear to my heart. We have already stated that there is a serious shortage of physicians. And this shortage is likely to worsen as the Baby Boomers continue to age; resulting in increased physician retirements and increased demand for services. But is there anything that can be done about this. What prevents us from simply training more physicians.

There are two major limitations. The first is that currently the medical establishment has limited the number of seats available to incoming first year students in American Medical Colleges. To the point that there are not enough graduates to fill available residency positions, forcing many hospitals to rely on foreign medical graduates to staff their facilities. The thinking has always been that by restricting the number of incoming students, it will be possible to guarantee that only the best and brightest are admitted.

Even more limiting is the expense of that education. In this country the average cost of a medical education is $207,866. This includes both private colleges and state-sponsored colleges. Compare this with just over nine thousand a year in the UK for five years of training, with a total cost of $45,000. The rest is underwritten by the government in return for their working for the National Health Service. They are, too a large extent, primary care providers who are paid a salary by the government and are protected from frivolous lawsuits, in much the same way as our physicians in this country are, who work for the military.

The government currently spends about 186 billion dollars per year on physician services alone while the cost of subsidizing the education of graduating medical students would be less than 850 million dollars a year. And for that investment, the cost of their services could be set by the government for those that chose to have their education paid for. There would still be those that wished to pay for their own education, which would place them in a position to share in greater rewards (by charging what they wanted and hopefully providing the services that some would want) and greater risks (being subject, as they now are, to the legal system). The beauty of this scenario, is that it allows current physicians to continue in a system that they have become accustomed to, while allowing future generations to “grow into” a National Health Service.

But for this to be successful, it requires that the legal system accept some measure of tort reform, and that the central government realize that by subsidizing medical education, in the long run, costs will come more under their control. A leap of faith, I must admit, but one deserving of serious consideration.

Also quotas would need to be established for the percentage of physician trainees that would go into primary care. While it might restrict the number of specialists trained as a result, at this time, the crushing need is for more primary care providers.

What about drug costs. Aren’t they becoming prohibitive for folks? Absolutely. But if we begin to develop a National Health Service, it will only make sense for the government to negotiate prices with pharmaceutical companies. This happens in every other industrialized nation. If you doubt that, you have no need to look further than to our neighbor to the north, Canada. While I was still in practice, it was not uncommon for me to become aware of my patients trying to buy their medications from across the border, risking legal action for breaking the law in order to comply with my treatment recommendations.

What about the costs of testing? If a National Health Service were implemented, with limited legal exposure, the need for duplicate testing would disappear, and only excessive testing done in clinically challenging cases would continue.

And hospitals? Well, it might require some changes in the services that they offer. It may be that the next generation of hospitals will only include an emergency room, an ICU, a surgical suite for major cases and, perhaps, a maternity ward. And with the plethora of physicians, home care and rehabilitation care will be more easily supervised in rehab centers and in the out-patient settings.

Would this work? You can talk to folks in other nations, who already have a universal system. Some of these are tiered. Some provide the same benefits to all their citizens. Most will say that their economy is still struggling under the burden of providing those benefits. But the costs are undoubtably lower than they are in this country. And all of their citizens get at least basic care when it is needed.

I would welcome any comments about these suggestions. It is only through dialogue that answers can be found. As I said at the beginning, if the solution were easy we would have one by now.

The Declaration of Independence, one of the cornerstones of our democracy, states that we have unalienable rights to “life, liberty and the pursuit of happiness”. If we still consider this to be the case, a corollary to having life is having access to health care. But many can’t afford that health care. The Affordable Care Act was meant to help our countrymen purchase it. But it has clearly fallen short. It leaves, unprotected, much of the middle class. Even with subsidies, health care has simply become too expensive.

One solution which has been broached is that of a universal health care program for all; essentially a Medicare for all. But with health care costs spiraling out of control, it is difficult to imagine what this would do to the national debt. Just ask some of our neighboring countries. But is there room for a tiered system of benefits?

Many rail against tiering, claiming that health care benefits should be equally available to all. That it is un-American to provide different levels of service based on an ability to pay. And yet, isn’t that what our current Medicare system does? Medicare only pays for 80% of a patient’s expense. Leaving it up to the individual to decide whether he can afford to take his medications or get his required therapy. Those whose retirement nest egg is large enough, can buy additional insurance plans which pick up the remainder of the costs. And, of course, we see it in other areas of our lives. Some can afford basic transportation, the Volkswagen Bug of old, while others can enjoy the luxury of a Mercedes, Audi or BMW.

But if life and health are to be considered unalienable rights, shouldn’t everyone be entitled to good health care? Absolutely. But are there extras we have come to expect, that may not be essential? Should we return to wards in the hospital setting, accommodating 6 to 10 patients, instead of the current semi-private or private rooms that have become the norm? Is it important that all elective surgery occur immediately when, by waiting, the current number of specialty surgeons can be more efficiently scheduled? Does everyone need to have multiple confirmatory tests for their diagnoses, when one or two are sufficient?

Clearly this is something that the UK has had to address. They have a basic tier of health care which is available to all. But the population can purchase supplemental insurance which can tailor the care to one’s wishes. Does this smack of elitism. I suppose that it does. But it depends on your priorities. At worst, even if health care is not a priority for you, you will be entitled to a basic level of services. Which is all we can truly expect from our taxes or our government.

But doesn’t the present system provide these basic services to everyone? I don’t see hospitals turning away the sick. Why should I pay for insurance to get what my neighbor gets for free?

A good question. And I suppose that this is at the crux of the matter. Our hospitals are currently required to provide “free care” to all those who present to them for care, who require it. And this mandate has resulted in the shuttering of many hospitals in recent years, whose bottom lines have not been able to support this benevolence. If we continue on the current trajectory, we may find, within another decade, that we have no safety net left for the uninsured.

But what about the cost? How can our economy afford taking care of its sick? Won’t the same economic forces threatening the closures of our hospitals, threaten the solvency of our country?

The short answer is yes. Unless we can rein in the costs of that care. Something that policy wonks have been struggling with for years. But what costs are we talking about? Medical tests have certain expenses associated with them which dictate their costs. Physicians are forced to adjust their fees to compensate for astronomical fees associated with their education. At present we have no ability to limit our exposure to the escalation of drug costs. And hospitals are confronted with the brick and mortar costs of their buildings and the attendant costs of staffing them.

So any solution to the current health care crisis must include an examination of the costs of the current system and how to modify them. Currently the price tag in its present iteration is 3.2 trillion dollars per year. Next time we will consider a couple of radical approaches that could be considered in devising a solution.