The United
States urgently needs a top-level national commission to reform its troubled
health care system and prepare for revolutionary changes in medical technology,
the head of a leading scientific organization says.
Floyd E. Bloom,
president of the American Association for the Advancement of Science, said
he would seek such a commission to solve the country's worsening health
care crisis, which involves soaring costs, critical staff shortages, massive
paperwork burdens and what he termed archaic methods of information management.
"The American
health system today is in serious crisis," Bloom told attendees at the
AAAS annual meeting in Denver. "It is failing before our eyes, despite
consuming a very significant percentage of our gross domestic product and
representing perhaps the biggest employer for most communities."
Even more worrisome,
from a scientific point of view, explained Bloom -- who is a molecular
biologist -- is the onset of "post-genomic medicine," in which the vast
and still-growing body of knowledge about human genetic makeup can be applied
to treat a host of diseases.
"The current
system can scarcely meet today's needs, let alone the cost of transition"
to the next generation of medical technology, he added.
Worse, Bloom
contended, progress toward health care reform seems stalled. He criticized
as inadequate the efforts by the Bush administration, one of the main components
of which is to limit malpractice awards by the courts for patient pain
and suffering.
"Unfortunately,
capping awards is not going to lead to the end of pain and suffering,"
he told meeting attendees.
"The rapidly-escalating
costs are present in all aspects of the health care system," Bloom said.
"The estimated total expenditures in 2002 exceeded $1.2 trillion (and)
the rise has again assumed a double-digit rate. This applies not only to
employer- based health care costs, but to both Medicare and Medicaid as
well. We are now approaching $700 billion for Medicare and close to $500
billion for Medicaid. These mandated entitlements are now approaching 15
percent of our gross national product."
Bloom listed
a litany of problems he said threatened to overwhelm both the current health
care system and the nation's ability to pay for medical services:
-- The uninsured number of
Americans continues to grow as business downturns have affected the ability
of small employers to pay health benefits, he said, requiring more and
more health care costs to be being passed along to employees.
-- Malpractice insurance
rates are driving physicians from their practices, "and in those states
where it has been most reprehensible there are extreme shortages of personnel,
in radiology, in anesthesiology, in neurosurgery and most important in
the nursing profession."
-- Overloaded clinicians
are more prone to make errors within a system that demands rapid flow-through.
-- Patients are unhappy
with the choices provided by their employers' plans, while physicians are
unhappy with the constraints placed on them by non-physicians, who decide
what tests can be given and what medications can be provided.
-- The care for indigent
patients, particularly in the southern states, is threatening already overburdened
state Medicaid systems.
-- Changes in U.S. demographics
have required increased attention to the chronic illnesses of an aging
population.
Bloom said he
is particularly concerned over the growing shortage of nurses "because
of the shortages of faculties at the schools of nursing able to train those
who are even attracted to the profession, which is one that's known not
for its good working conditions, not for its good working hours or for
its good pattern of remuneration for services rendered."
Given these
current trends, there is a "very real possibility that the essential role
played by nurses throughout our medical past may come to an untimely and
a definitely unwanted demise," he continued.
"Everyone has
a suggested solution," Bloom said, "but it's not clear what the right solution
is."
Current -- but
partial -- proposed solutions include states paying for malpractice insurance,
the administration's ideas of limiting malpractice awards and strengthening
drug benefits for those under Medicare -- the latter only for the elderly
who are willing to buy into a private medical reimbursement plan.
"No one is dealing
with continually rising costs, the lack of trained personnel, the rise
of the uninsured, the insatiable hunger for more and more health services,
and the nearly complete failure of self-responsibility for health improvements
through diet and exercise choices," Bloom declared.
He also noted
what he called the "extreme burdens of indebtedness that are accumulated
through a medical education," as well as "the loss of what was once a profound
community" of teaching hospitals, where patients could be treated for nominal
fees or for free in exchange for allowing themselves to be treated as part
of the medical education process.
As serious as
these problems are, Bloom said, they are likely to grow worse in the future
if not addressed because the benefits of new medical research are being
"lost in a sea of overwhelming knowledge." Managing such information is
difficult enough for ordinary scientists, he added, but they are even more
critical "for those engaged in life-and-death situations."
The health care
system must be adapted to absorb the exponentially growing knowledge, Bloom
told attendees. At present, there are more than 10,000 drugs, more than
100,000 diseases and conditions, thousands of guidelines for how to use
those medications "and millions of rules that lie between the conditions
and the medications."
For all these
reasons, Bloom said, "I believe it is time to create a national commission
to restore the American health system." However, he added, "The AAAS is
a general scientific society. We cannot drive such reform ourselves. Our
commitment to advance science and serve society demands that we seek such
reforms -- and do so promptly."
--
Copyright 2003 by United
Press International.
All rights reserved.
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