Adapting Health Care to the 21st Century: Policy Solutions for the Future

Modern medicine has made immense strides in eliminating dangerous diseases and protecting humanity. From treatments for smallpox to those for AIDS, this development has increased life spans and allowed population of our planet to rapidly expand. While medicine’s evolution is widely considered a success story, the advent of new technology and the evolution of medical care in the United States has created some ethical dilemmas, stemming from fair distribution of care, over-testing, and privacy concerns.

Widening disparities in our medical system cause unnecessary deaths and ailments all across America. While the majority of Americans receive some form of medical care, over 46 million Americans still lack access to health care, reflecting the wide gap in distribution [1].

One of the largest causes of disparities in medical care is poverty. There is a strong correlation between poverty and poor health, suggesting that socioeconomic inequality is one of the largest causes of the unfair distribution of care [2]. Those who are in lower socioeconomic status do not have adequate access to health facilities because of exorbitant costs. To make matters worse, government programs do not have sufficient funding and cannot assist low-income families [3]. Fareed Zakaria, editor-at-large of Time Magazine, reports that “one out of every five dollars spent in America is spent on health care,” highlighting the excessive cost of health care in America [4].

Another contributing factor is ethnic and racial differences. For example, minorities are more likely to die from ailments like cardiovascular disease and cancer [3]. A report by the Health Policy Institute of Ohio attributes these incongruences to a few significant factors, including a lack of coverage by insurance companies, the absence of readily available medical care, financial inadequacies, a lack of preventive care and health education, and legal obstacles for immigrants seeking medical assistance [3].

Finally, a large gender gap exists. While women have been making strides in most fields, health care reform has done very little to change the gender gap in medicine. Insurance companies can still discriminate levels of coverage based on gender, and in many states, women are forced to pay more for health coverage than men [5,6,7]. Insurers have no incentive to close this gap because the disparity allows them to make larger profits.

At the same time, patients from all walks of life with specific health conditions do not receive adequate care because insurance companies have the option of rejecting patients when they are not profitable enough to cover. 89% of Americans who are looking for individual health care do not receive insurance and are forced to pay the steep costs for medical care [1].

The solution to most of these problems lies not in improving medicine alone, but in improving existing policies that address these issues [8]. While the recent Patient Protection and Affordable Health Care Act passed by Congress offers solutions to some of these problems, the act does not provide adequate protection of the underprivileged and does not ensure medical care for those who need it the most. The act is often referred to as creating a universal health care system. However, the law does not guarantee that everyone has access to health care. It merely taxes households that do not have insurance with the hope that they will acquire it. A truly universal health care system would nationalize the industry but distribute care through private entities to ensure maximum efficiency and fair distribution of care. The successes of the Swiss and Taiwanese health care systems prove that such a system would lower costs and provide more fairly distributed care [9]. Regardless of the policy details, though, the health care industry must be driven solely by the intent to serve the public and improve the quality of life, rather than profit-making.

Although new tests and drugs have led to the early detection of diseases, the testing epidemic has created unnecessary diagnoses and dangers for patients. Doctors today conduct 70 million computed tomography scans (CT scans) every year, up from 3 million in 1981 [10]. Prescribing additional tests increases patients’ exposure to radiation. CT scans cause 30,000 new cases of cancer every year in the United States alone [10]. Additionally, each CT scan exposes the patient to 600 times as much radiation as an X-ray machine [10].

A recent study by Gina Kolata of the New York Times reveals that MRIs and other tests often expose issues that are generally harmless [11]. In the study, 31 professional baseball pitchers were scanned using MRI technology, and 28 of the pitchers had abnormalities in their throwing arms. However, all of the pitchers felt no pain or discomfort, even when using their supposedly defective arms [11]. Besides exposing patients to radiation, over-testing can lead to the detection of harmless abnormalities that may then be treated with unnecessary procedures. These procedures sometimes cause side effects and cause more harm than the so-called defect itself [12].

Over-testing in medicine is also one of the primary causes of the inflated costs in today’s medical system. According to Ezekiel Emanuel, a professor of health policy at the University of Pennsylvania, the U.S. spends the most on health care in the world, approximately 35% more than the next-highest nation, Norway. Meanwhile, Americans still rank 36th in the world in life expectancy [11].

Furthermore, current malpractice laws encourage “defensive practice,” forcing doctors to prescribe more tests to avoid legal liabilities [10]. Contrary to common belief, a CT scan does not necessarily increase the accuracy of diagnosing heart disease [10]. Reforming malpractice laws would allow doctors to practice medicine without having to worry about possible lawsuits; policymakers can then control the over-testing epidemic in America. Doctors should limit extraneous tests by completing thorough clinical examinations and by only prescribing tests when actually needed.

However, the solution to this issue needs to be more than just a commitment to reduce the levels of testing. Superficially, testing appears to be a win-win situation for both doctors and patients. Often, doctors make much larger profits by prescribing more tests, and patients feel safer when they are given more tests, making them more likely to visit the same doctor [11]. Rather than charging patients for each test, clinics should charge flat rates per appointment, thereby reducing the incentive for doctors to prescribe unnecessary tests. Additionally, patients should be educated about the potential hazards of over-testing, and doctors should take into account patients’ testing histories when making decisions about medical tests [13].

Doctor-patient confidentiality is crucial to successful medical practice, and doctors, under the Hippocratic Oath, promise to keep private all information about their patients. The Stanford Encyclopedia of Philosophy defines the security of medical records as one of the “paramount professional responsibilities” of health care providers [14]. New technology has disrupted this careful equilibrium since records are not entirely secure when electronically available.

Developing electronic medical records has been a top priority in the legislative, political, and corporate arenas as a way to eliminate inefficiencies in the system and ensure the best care [15]. Electronic medical records always have a chance of falling into the wrong hands or of being distributed without permission, creating privacy concerns for both doctors and patients [16]. Recently, databases for several providers, including Kaiser Permanente and Stanford Clinics, were breached, affecting nearly 10,000 patients [17].

Current federal laws do very little to protect patients’ privacy with electronic medical records. The laws only protect information that relates or belongs to federal agencies but leave out information that exists in databases outside the federal system. On the state and local level, laws do not protect medical data that is in electronic databases [18]. The Department of Health and Human Services has facilitated the transition to electronic health records, but the department has not mandated specific regulations regarding the security and privacy of these records [19].

After a thorough investigation, the U.S. Institute of Medicine came to the conclusion that while electronic medical records are crucial to sustain the industry, current privacy regulations are not sufficient to protect patients. The Institute recommended that the databases be made fully secure against breaches and that the government set up a strict legal framework for use of electronic records in the private sector [15][20]. The report also suggested that audits be conducted in an effort to enforce these regulations.

The rapid expansion of medicine has undoubtedly been a boon for humanity and is largely responsible for its welfare. While medicine’s success has been truly revolutionary, the potentially dangerous impacts of inequitable distribution, over-testing, and inadequate regulation must be addressed. By carefully considering and addressing these concerns, modern medicine can truly become a success story rather than a victim of its own success.

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Ayush Midha is a student at the Harker School. Follow The Triple Helix Online on Twitter and join us on Facebook.