The author of this article falls victim to the type of fault that he seeks to illustrate. He spends paragraph after paragraph telling us about what he percieves as the problem, while devoting precious little time to discussing the solution. Even in the comments that I have read on this article so far, few have focused on how to fix the problems that they so passionately rant about.

Let's change the focus here.

I am the practice manager for a private Family Practice clinic in a rural area. As such, I deal intimately with both the clinical and economic realities of the practice of medicine in our country on a daily basis. As far as I'm concerned, both the diagnostic focus maligned in the article, and the treatment-oriented apporach advocated by the author, miss the point that lies at the root of the failings of our current apporach to medicine: Both of these appraches address treating disease after it has already occurred.

The horses are already out of the barn. Elvis has already left the building.

The only way we can truly begin to address the healthcare crisis that is emerging in this nation is to recognize not only the value, but the absolute necessity of preventive medical care.

Many of the conditions that physicians rush to daignose and treat in shrinking windows of time with diminishing reimbursement are preventable. Even with existing conditions where disease is already diagnosed, efforts can be made to reduce the damage caused to physiological systems by the disease state. All elements of our healthcare system, from insurers to providers, must begin to realize that early control of conditions, even and espeially before they become symptomatic, will save us all billions of dollars in overall healthcare costs in the long run. If insurers, in particular, were to act on this fact, we might really begin to create a healthcare system that serves both our citizens and our economy.

Reimbursement for medical tests and treatments is based on an outmoded, diagnosis dependant model. Insurances reimburse screening for most conditions only in the presence of clinical symptoms or demographic factors which indicate that the presence of disease is more likely. We are thus prevented from screening to prevent disease, but forced instead to confirm disease that we suspect may already exist. Insurances will only authroize payment for medications to treat disease states that are already advanced to the point of being symptomatic. The damage is already being done, and we can only reduce the amount of harm, and the rate at which it occurs. This reactive posture must change for meaningful reform and cost management to occur.

One of the keys to all of this lies in the recognition and adequate compensation of primary care practitioners. These practitioners on the "front line" of medical care are ideally placed to provide the kind of proactive care that is so deperately needed. Embedded in their communities, and armed with adequate time to build comprehensive family histories and provide thorough patient education, these providers can and would revolutionize the state of healthcare in this nation.

The key factor above is time. As we all know, time is money. The problem lies in the fact that primary care remains the most inadequately compensated segment of our healthcare system. In response to shrinking reimbursement, primary care providers are forced to see an increased number of patients each day to compensate for lost revenue. The result is that less time is being spent with each patient, which leaves the provider with little time in which to get histories and provide the education that is so desperately needed to provide a new, solid foundation to our healthcare system. Furthermore, the poor salary that is earned by these most desperately needed providers attracts fewer and fewer of the best and brightest minds that come out of our medical educational system. The most promising graduates move into specialty training that often focuses on the care of those who are already desperately ill.

Can you see the problem here?

We should reward the prevention of disease, not the treatment of it. We should not react to a diagnosis, but prevent it from ever being necessary. The cost savings that would be realized by a proactive approach to healthcare would allow for greater compensation of the primary care providers who could make it happen, which would in turn attract more of our finest to those arenas of care. This would then allow us to become even more effective at preventing disease. With greater research into the genetic and environmental underpinnings of disease and preventive treatments based on that research, we could truly move into the kind of medical future that we all should be working toward.