This column -- a new venture -- is for you: And for me. It is for us patients.
Being a patient was never easy, and now it's getting even harder.
Some doctors are highly expert, some are not. Going to the hospital can be healing, but for some it can be a jolting, even dehumanizing experience. Durgs often cure, but they can also do harm. Medicine is getting more and more technological, doctors are getting more and more specialized, payment plans more and more confusing.
There is a "major upheaval" taking place in health care, says Harvard sociologist Paul Starr. Massachusetts health commissioner Bailus Walker, calls health care "chaotic" for many citizens, and Eli Ginzburg, Columbia University economist, says the health industry will see more changes in the next six years than it has in the last 36.
Dr. Evelyn Hess, director of immunology at the University of Cincinnati, puts it this way: "It's beginning to be quite a jungle in the private world of medicine."
We don't just "go to the doctor" anymore. Many of us -- including government workers, private employes and even Medicare recipients in some cities -- must decide periodically whether to stay with our present doctors and health insurors or join a Kaiser or Group Health or University or Whatever New Name Health Plan. These are the "Health Maintenance Organizations" or HMOs: prepayment plans staffed by groups of doctors who claim to provide almost all the medical and hospital care we need for a fixed fee per month.
These HMOs are growing fast. In 1972 they enrolled 4.2 million Americans; by June 30, 1983, 12.5 million; today, something approaching 15 million. In one HMO hotbed, Minneapolis-St. Paul, a third of the population -- and half of all employes covered by group health insurance -- belong to HMOs.
Even in Washington, long a non-HMO town except for the pioneering Group Health Association with its 100,000-plus members, there is a new immigrant from the West Coast: Kaiser, the original HMO. Kaiser has converted a faltering Georgetown University plan into Kaiser-Georgetown and already has 122,000 subscribers.
Traditional private-practice doctors have fought the HMO challenge by forming IPAs or Independent Practice Associations, which are alliances of several doctors who offer care for a monthly prepayment.
There are also growing numbers of doctors. In 1963 there were 247,000 practicing doctors in the United States; in 1983, 425,000.
So doctors are competing with each other by trimming fees and posting prices, making special deals for large groups, offering new services, advertising and marketing themselves and catering to patients with "quick-care" or "emergicenters" at shopping malls.
Hospitals are competing and advertising too. They're starting to bargain with employers and health insurors on group rates. Individuals may also benefit. Shady Grove Adventist Hospital in Rockville offers a 24-hour maternity stay for $1,175, excluding doctors' fees. The average three-day stay costs from $1,800 to $2,000.
Then there's the complex question of paying the bill.
For a long while employers, health insurors and the government seemed eager to add to our health insurance. Now they are all either cutting back or considering cutting back. More and more, they're saying, "Not covered."
Government and business and health plans are also putting great pressure on doctors and hospitals to spend less on caring for us. This is certain to mean doing less and, sometimes, not doing enough.
One of the newest elements in American health care is "rationing": deciding which tests and procedures will be permitted and which will not. Medical rationing has long been applied to the poor -- they often have been relegated to sub-standard clinics and hospitals. Now rationing is becoming a fact for everyone.
All this means we need some new guides.
How can we find a doctor who will care? How can we tell whether he or she is a good one? Who should be our primary physician: an internist, a family practitioner or, for a woman, a gynecologist?
Should we join one of the new plans? Which one? What's the best deal in dollars and cents for an individual? For a family?? Should we patronize one of the new walk-in clinics? Where can we fill our prescription for less? Can we rely on an over-the-counter drug instead of a prescription?
I'll try to answer questions like these in The Washington Post's new HEALTH section. I will call on knowledgeable doctors and other health professionals -- and fellow patients -- for the answers we all need.
The medical system, as complicated as it sometimes seems, helps most of us and helps us wondrously, compared to the medicine of only a few generations ago.
But whether or not we get good care depends not just on doctors. It depends on us -- on how well or ill informed we are and how willing we are to meet the medical system half-way. To learn to take responsibility for our own health.
We patients, perhaps beguiled by those wonderful television docs, often confer on physicians what has been called "the fantasy of certainty." Dr. Lewis Thomas of Memorial Sloan-Kettering Cancer Center in New York reminds us that physicians have merely progressed from total ignorance to becoming aware of their ignorance.
That is an exaggeration, but it is at least a half-truth. We patients, as well as the doctors, have to deal with medicine's uncertainty. But we can do better if we acknowledge it, then do our best with the information we have.