It is not that the conversations evolve around national issues on a regular basis; far from it. Why the kids are wearing sandals in the middle of January, or who needs rides and where this weekend is usually the extent of household management decisions on a regular basis.

However, my intimate business associate (together, we have invested in a bed, house, cars, gold rings on third fingers, etc.) has decided to take a course in “Delivering Health Care in America: A Systems Approach.” So the hot topic each night is the list of questions at the end of each chapter of said textbook. Most recently the essay question is, “Should the U.S. have a single-party health care system?” Answer: For the record, I don’t think so.

It is hard not to have an opinion, having participated in the delivery of health care (wink, I am an obstetrician) for about 24 years, the past 16 of which have been in Lewiston. As I witness my wife drilling down for answers to provocative questions regarding the behemoth that is 20 percent or so of the nation’s GDP, it strikes me that the system, as we know it, doesn’t lend itself to easy explanations.

When I was about 8 years old, I received a nice little gash that required 15 stitches in the accident room. It wasn’t the first time, nor was it the last time my mother would drag me there, but it was the stitch record at the time. One week later, Dr. Dashef charged us $15 — $1 per stitch — to remove them. That was the last time he got to do that. “Fifteen dollars to remove a few pieces of thread? I could’ve done that,” and so began my mother’s hobby as a physician’s assistant.

Looking back on that and understanding a little more about markets, what the good doctor did was price himself out of the market. There were alternatives to consider, based on transparent pricing. The medical decision tree had few branches. This is what you need, this is what it costs. You decide.

How far away have we gotten from that?

Has the nationalization of certain components of the health-care system made the system better? Maybe, but by incorporating federal and state money, and the accompanying bureaucracy to tend to them, we’ve certainly made the decision and paperwork process more cumbersome and, dare I say, phenomenally less efficient.

As this is just a “discussion” question, we won’t get too specific about third-party payers, access to care, customer satisfaction forms following each medical encounter, DHS reporting requirements (at age 6, I fell out of a moving car — my mother would be in prison now. Did me no good then; I got yelled at by my father and a stern look from the doctor, who proceeded with another four or five stitches), and the list goes on.

We’ve all had our encounters with the modern health-care system and often the encounters are more complicated and expensive than they need to be.

We take it for granted that decisions about our own health care are not ours to make sometimes. I don’t think that is a good thing.

Those in need of medical care should be able to afford medical care, or the insurance to cover unforeseen, expensive interventions. Pricing should be transparent and individuals should be capable of purchasing health care that is competitively priced in the market.

The federal and state governments should be a backstop to provide dollars and only the broadest of guidelines for the delivery of health care.

Oh, and the next assignment is the economy, which is 100 percent of the GDP.

Discussion question: Since the federal government has done such a fine job of affordable health care in the U.S., shouldn’t it nationalize the banking system? And the follow-up question, if the U.S. goes bankrupt, and you could only afford one pair of sandals to wear in January, what would they be?

Thomas Page is a practicing OB/Gyn in Lewiston since 1996. He lives in Leeds and is married with five children.

Copy the Story Link