Reality

I keep on wondering how it is that so many of us see so little of what is real. There have been many discussions this week with patients about health care financing. I guess this is just becoming an immense issue. People are losing physicians due to changes in insurance. There is concern regarding the socialization of medicine (which is almost surely coming). There is concern about the cost of insurance premiums. People seem to think what they seem to think. It's interesting because the basic reality isn't even up for discussion.
One thing that is problematic is that no matter what anyone says, no one actually knows how to measure quality of health care. We can't measure the quality of care that a physician provides as a physician to his patient population. We don't even have honest discussions about what are the criteria. For example, if I caused the death of a patient through error, what does that mean? How many deaths per patient encounters can someone have? If I save a life that no one else could have saved (how would you know that, of course) what does that mean? I pick on that because we all agree that we can actually measure if someone is alive or dead. We don't have agreed upon standards for how to measure overall pain levels. So we can't actually compare whether I alleviate more pain or less pain than another physician who tries to alleviate pain. We could easily measure patient satisfaction and quantify it, but we don't routinely do that, nor do we accept the notion that overall patient satisfaction is relevant or important in measuring physician quality. This is reality, but it is unpleasant.
What about system-wide quality? We can measure infant mortality pretty well. Ours is too high. We can measure lifespan of a population (ours isn't high enough). We can measure vaccination rates. These things are in fact important to some extent. They are actually what is used to measure quality of population health care systems. Patient satisfaction is not considered an important measurement of population health. Neither is access to "elective" surgery or procedures.
If we change our system to a socialized one we will have less infant mortality and more vaccination. Our population lifespan will increase (because less babies will die). The people who have no insurance now (50million) will have access to basic health care, including primary care (which may be done by nurses mostly). Their health will DEFINITELY improve. The people who are currently in medicare or receiving private health insurance care, however will see a decline in certain things. They won't get to use so many fancy tests, see so many doctors so quickly, have so many specialists take care of things that are complicated, or get so many fancy medications (which are sometimes superior to the older ones). The older people will die a little more often a little sooner with a little less care. The patient satisfaction with the system and with their own personal physicians will decline. This is what will happen. Is it good? Is it bad? I don't know any of that. I'm just stuck on the fact that no one seems to look at the reality of things. It isn't free. There are trade-offs. It's very hard. There are ugly questions about value. The politicians and the thirty-second spin artists want to have one-liners about nothing. They want to claim things like "better quality" when no one even knows what that means!
It's frustrating. I would like to see someone in the public arena actually have a real discussion about health care because it's important.