Dr. Jeff Hersh: Health system needs more than money

Dr. Jeff Hersh

Q: My brother, Mr. Know-It-All, didn't believe me when I told him about a free medical clinic in Virginia run by volunteers. He said it must have been in some Third World country because that kind of thing was not needed in the United States. Who is right?

A: You are. I believe you are referring to the medical and dental expedition set up by Remote Area Medical in Virginia just last month. Yes, here in the United States, not in some developing country.

RAM is an amazing group that has held free medical clinics in the United States and abroad. (Learn more about them at www.ramusa.org.)

The good news is that the 1,800 RAM volunteers saw more than 2,500 patients in 2 1/2 days. The bad news is that they had to turn many people away.

Many people do not realize that access to medical and dental care is limited for many Americans. There are more than 47 million uninsured Americans, about 16 percent of the population, including more than 9 million children. Add to this the estimated 12 million illegal immigrants, and you can begin to see the magnitude of this issue. Throwing $35 billion at this problem (the amount spent providing the limited care these people receive) has clearly not solved it.

These numbers are for medical care -- the lack of dental care is also a huge issue. The American Dental Association estimates that for every child without health care insurance there are more than 2.6 kids without dental insurance. That means that more than 23 million American children do not receive adequate dental care, creating lifelong dental (and medical) problems.

Having insurance is not a cure-all. About 20 percent of Americans report a delay or inability to get timely health care even though they have insurance. Having Medicaid dental insurance is a pronounced example of this; finding a dentist who accepts Medicaid can be challenging or even impossible. This is true for the 29 million kids who have Medicaid dental coverage. No wonder the dentists at the recent RAM event in Virginia pulled almost 4,000 teeth in just 2 1/2 days.

The U.S. must provide health care to all its citizens, just as almost every other industrialized nation does. But to do this we will have to go further than just requiring people to get insurance and throwing money at the problem. We already spend about 16 percent of our gross domestic product on health care, and this is estimated to rise to 19 percent by 2017. We must address some of the underlying inefficiencies of our health care system:

- 30 percent of our health care dollars go to administrative costs, compared to 15 percent in Canada.

- Overuse of technology is not only expensive, it can actually be deadly.

- Almost 30 percent of all Medicare dollars are spent on patients in their last year of life.

- Money spent by physicians practicing ``defensive medicine'' to protect themselves from malpractice lawsuits is huge Á some estimates are that 20 percent to 30 percent of the care actually delivered (tests ordered, procedures done and medications prescribed) is unnecessary.

There are many wonderful groups out there providing free medical care to those in need. As inspiring as this is, it is only a bandage on the overall problem, not a solution.

The U.S. spent more than $2 trillion on health care in 2006, but we are not getting good value for our money. As the population ages and the need for health care grows, we are likely to be forced into accepting solutions that will be very unpopular. It is surely wiser to address the issues head on and make the best decisions we can before it is too late and our options are even more limited.

Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.