Christopher R. Cogle: Historic health care transition

Published: Sunday, November 1, 2009 at 6:01 a.m.
Last Modified: Friday, October 30, 2009 at 4:41 p.m.

Today, doors close at Alachua County’s General Hospital, while a little over a mile away doors open for the first time at Shands’ new Cancer and Trauma Hospital.

These simultaneous events highlight the best and worst of today’s health care “system.”

When Alachua General Hospital first opened, in 1928, Copeland’s hog processing plant in Gainesville began its five decades of sausage making, Dr. Sarah Robb, Alachua County’s first woman physician, administered common sense medicine, Herbert Hoover (R) was elected president, and Mickey and Minnie Mouse made their film debuts.

Back then, when you got sick, you paid what you could, and not always in money.

Eighty-one years later, Gainesville’s hog warehouse has since closed due to the cost of production and outdated infrastructure, Dr. Robb’s office is now Florida’s oldest medical museum, and the Republicans have been ousted due to, well, outdated infrastructure.

Now, when you get sick, you either go into catastrophic debt if you have no health insurance or you go to someone that might accept your insurance (which you and your employer paid dearly for) and likely still have to pay more at the time of the medical visit.

Bartering for medical care with chickens and oranges is no longer an acceptable form of payment at most hospitals and clinics in Alachua County.

This weekend’s historic transition in Alachua County from general hospital to specialty care brings into focus the true arc of health care in our community and nation.

Today’s health care “system” in the U.S. relies on intricate interactions between generalist and specialty physicians and, unfortunately, with predominant appeasement of insurance companies.

There are many reasons why we’ve arrived at this point. Most importantly, there is so much more known about diseases from biomedical discoveries, such as DNA in the 1950s, that it often takes the focus of a specialist to diagnose accurately and treat precisely.

For example, patients presenting with acute myeloid leukemia should be checked for an internal tandem duplication in the FLT3 gene in addition to standard chromosome analysis. And if the patient’s leukemia is FLT3 gene mutation positive, the patient should be offered aggressive treatment, including allogeneic blood and marrow transplantation; which is only offered at tertiary care centers like Shands’ new Cancer Hospital.

Asking a family practice physician or even a general oncologist to deliver primary care for this kind of patient throughout the entire spectrum of diagnosis, chemotherapy, stem cell transplant, after transplant care and survivorship is not feasible or safe. Rather, our medical community works as a team with captains of care leading when his/her expertise and experience benefits the patient the most.

This dynamic nature of physicians working in concert for the benefit of the patient is the cornerstone of any future accolade of the “best medical care in the world.”

Alachua County’s physicians (private, university and Veterans Affairs) are the finest in the state and nation because of their collective and interactive breadth and depth of knowledge.

However, our nation’s health care “system” caters to insurance companies rather than patients.

This isn’t surprising given our nation’s relatively recent history of offering health insurance as a benefit to employment (rather than wage/salary increases) and federal tax benefits which provided incentives for health insurance companies to grow catastrophic coverage into “comprehensive” coverage (provided a company monitor approves).

Even before the sacred doctor-patient encounter, contracts and agreements are made between doctors/practice administrators and select insurance companies to secure the best mutual financial relationship.

As a consequence, patients are often clueless on how much exams, tests and procedures cost.

And try finding out. It’s not a straight answer. It depends on your insurance company (if you have one).

Worse in this dizzying “system” is that patients have no ability to directly compare quality among insurance companies or health care providers.

Federal protection of for-profit insurance companies, lack of transparency and a hodgepodge of companies making money by withholding care, does not and cannot support the “best medical care in the world.”

Unfortunately, the health care reform proposals currently receiving the most attention nationally are based on tweaking our patchwork of corporations rather than getting to the root of the problem.

Several elements of the forefront proposals are progressive, such as mandating electronic medical records and eliminating pre-existing conditions. However, further regulations, hamstringing an already flawed mishmash of company coverage, is unlikely to bring the reform that our community and country deserves.

True reform will require us to innovate a uniquely American solution, rather than blithely adopting another country’s plan or shuffling the status quo in avoidance of making hard decisions.

Possible, yet bold, solutions include eliminating insurance companies, adopting a single payer system and/or creating true health savings accounts with inheritance potential and without choking restrictions like today’s version.

With Alachua General Hospital’s passing, our community births a new tower of cancer and trauma.

It’s up to our elected policymakers and their staff to muster the bravery for true health care reform now. I look forward to the closure of the new hospital consequent to universal health care access, effective prevention and new cures.

Let’s hope it won’t take another 81 years.

Christopher R. Cogle is a physician-scientist in Gainesville.

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