Start small to fix health care

The Gazette Opinion Staff
Published: December 19 2013 | 12:01 am - Updated: 29 March 2014 | 1:02 am in
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By Dr. Mark J. Tyler


As a practicing physician, one of the truly rewarding joys was the one-on-one, personal relationships established with my patients. I believe it benefited both of us and it certainly allowed me to be a better physician for my patients.

What I am witnessing today, in my opinion, would seriously harm, if not destroy, what is the basic tenant of any provider/patient relationship: trust.

I was not employed by a system when I first started. I attempted to give the best care possible to my patients regardless of any other circumstances, including ability to pay. In my later years, when I became employed by the Mercy system, I/we did not change that template. But that decision, with my partners at that time, did free us from the complexities of the business side of medicine and allowed us to concentrate more fully on delivering the best care possible to our patients.

The Affordable Care Act, or Obamacare, is now under extreme debate with varying and divergent opinions. We are somewhat insulated here in our great state with reference to what transpires elsewhere, but that surely will change with time. However, the ACA appears to be the exclusive domain of the Democrat Party. I do not remember one idea or suggestion by the Republicans that was included in the final document. Why? Because it was the president’s signature domestic legislation and because they could.

If the Republican suggestions had been included in the legislation, I do not believe we would be witnessing the vitriol that is currently present. They have no “skin in the game.” ...

Very few laws have the ability to touch directly and substantially the lives of all of our citizenry, but the ACA does accomplish that very fact. Our health is dependent upon many factors, not the least of which is genetic heritage. Some of us are blessed with genetic longevity while others are not.

So much depends upon our habit patterns. Maintaining an ideal weight, beneficial diet, and routine exercise impacts greatly many adult health problems. We certainly know that minus a genetic predisposition, an obese person who does not exercise will be much more likely to develop hypertension, diabetes and arteriosclerosis (hardening of the arteries), and a shortened life span.

Why could not the federal government follow the lessons of our forefathers and any private entrepreneur and start “small” to see if that works? Correct the mistakes, change what needs to be changed and then progress.

The ACA risks its own demise solely because of unforeseen and possibly foreseen problems that defy easy solutions and quick resolution. I believe it would have been avoided or mitigated only if it had shown compliance and success on a smaller scale.

As I have stated before, we already have in place a system that does work and it is called Medicaid. It is not perfect but at least we are familiar with its use and its guidelines. I would suggest that we enfranchise the next 15 percent to 20 percent of our population above the parameters for Medicaid as it exists. Give the physicians, extenders, hospitals and our population a time frame to understand their responsibilities within the arena.

Once that is realized and accepted by everyone, then enfranchise the next segment of our population in a stepwise fashion until everyone is covered over an agreed time frame. This would allow us in a prudent and timely fashion to make sure we get it right, to have everyone’s input and to make changes that benefit everyone.

I would also suggest that the existing insurance companies be part of the process as they know how it is done. After all, we are family and we are in this together.

Dr. Mark J. Tyler has practiced medicine in Cedar Rapids since 1971. He also was longtime medical director of the Cedar Rapids Physician Hospital Organization. Comments: Dr. Tyelr, c/o 7 High Ridge Ct., Cedar Rapids, IA 52403

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