In the Guts Of Health Care

I will try in this book to share with you my own experience as a practicing physician in an attempt to shed some light on the difficult subject of health care reform that challenged our imagination for decades. I bring with me personal knowledge of different systems of health care as I grew up and worked in a socialist country then immigrated and worked in the United States where different rules determined how health care was delivered.

My passion for health care reform started when I was in medical school in a country where poverty, ignorance and limited resources made it difficult for the doctor to give, and the patient to receive, the proper health care. This passion increased as I felt the pain of my patients and confronted their fears and hopes which convinced me that the primary duty of the doctor was to care for his patients’ needs and not just to accumulate money. I saw the reverse happening in the fee-for-service system, which invited abusive behavior from doctors and patients alike and produced the unconscionable escalation of the cost of health care. As a consequence, we became victims to the more abusive system of HMO’s and managed care.

You have to be in the guts of health care to know its complexities. You might need to arm yourself with insights into the plethora of disciplines that are required to navigate through its intricate convolutions. You might need, at the same time, to be a doctor, a patient, a hospital administrator, a lawyer, a pharmaceutical executive, a judge and a politician to understand what’s going on. However, just being a human being is all that you need to find your way.

I do not claim to be all of the above; no one can. But, at least, I am a physician and a patient myself and I have certainly dealt, like most of you, with all the other players who have a say in what we call health care. I fought my battles with the government, the health care insurance companies, the medical establishment, the legal system and the ups and downs of a long career and became convinced of the need for a final resolution to a clearly defective system. It is enough to know that more than forty million people in our country are without health insurance, that an equal number is underinsured, that a large number of our children are not immunized and that some of our senior citizens have to choose between filling their prescription or buying food to make you see the need for definitive health care reform instead of the patch work that we have been doing until now.

I bring with me my own experience as I worked in the fee-for-service and the managed care systems. I bring with me the contrast of a different culture, basic and spiritual, but certainly as human as our own. I bring with me the lessons I learned from my teaching years and my daily rounds in the sacred corridors of medicine. I bring with me all the baggage and I’ll spread it all in front of your critical eyes that you might see and think and, hopefully, find your way through the complex world of health care.

This book is not an autobiographical narrative about myself though it might seem as such in some instances. It is in fact about you who actually supplied the stories, the inspiration and the human dimension when you walked into my office and touched my mind and my soul and made me determined to look for a simple, manageable and cost effective way to deliver care to our patients.

I intend to take you in this book on a journey through the guts of health care, and I promise to tell you the whole truth as I saw it. I’ll hide nothing, not the nutritious juices nor the filthy refuse. So, let’s start our journey.