Go ahead, just try to make my health-care job obsolete

By Laura Weil

Op Ed published in The Journal News, February 17, 2009

President Barack Obama has signaled in a number of ways that health-care reform will be a priority of his administration, a development that is most urgently needed. Not even here, in the relatively wealthy Lower Hudson Valley, is our health-care system meeting our clinical, emotional or financial needs. The fact is, the United States spends more per capita for health care than any other developed country, yet we consistently measure far below most of them in the health of our citizens.

According to the Robert Wood Johnson Foundation, in excess of 6 percent more of our gross domestic product is spent on health care than in other developed countries—and we are truly an extreme outlier, not even close to the next-costliest health-care system. The Commonwealth Fund reports that our health system ranks one-third below the best country on measures of death from medical conditions considered "amenable to health care." Our infant mortality rate, the highest in the developed world, is a national shame. We rank 33rd on a United Nations list of neonatal death rates, with 6.3 infant deaths per 1,000 live births. A shocking number considering Iceland's top-ranking score of 2.9. In other words, citizens across the U.S. are dying from illnesses that could have been prevented or effectively treated with timely, high quality care.

One of the ways that we have been coping with this severe inadequacy has been the work of patient advocates, health-care professionals whose job it is to help patients manage their interactions with the health care system.

Recently, U.S. News and World Report cited the patient advocate as a "cutting edge career" for 2009. This prediction is an astounding development, clearly indicating that the catastrophic shortcomings of our system have finally reached the tipping point in public awareness.

U.S. News identified patient advocacy as a growth industry because it has become an unfortunate fact of life that sick, and often frightened, people need help navigating our fragmented and discontinuous health-care system. They need access to good and consistent primary care that keeps them out of emergency rooms. They need help fighting denials of care by our for-profit payer system. They need someone who can help them access information, identify clinical centers of excellence, and manage the complicated and often cryptic minutiae of medical bills and insurers' explanations of benefit. They need someone to talk to, someone knowledgeable who can be a consistently available contact and support as they plot an often frightening course through diagnosis, treatment and recovery.

Patient advocates provide this support. Sadly, such support rarely comes these days from family physicians—whose ability to spend time with patients is compromised by unrealistic insurance reimbursements and the resulting need to see more patients in less time, in order to underwrite the high costs of practicing medicine. Add to that our increasing reliance on complex medical technology, clinical micro-specialization, and the transfer of patient care away from the primary care physician to unknown and often geographically remote specialists. It's no wonder then that the demand for patient advocacy is expected to surge. Patient advocates, like myself, would love to see our profession disappear, made redundant by a rational system able to meet the needs of people seeking medical care, to keep people healthy and able to be contributing members of society, and which didn't impoverish patients—sometimes even those who have health insurance.

We have gone off track, focusing health-care dollars on often unnecessary high-tech tests and interventions. Doctors don't get adequately reimbursed for listening to patients, for partnering with them to develop sensible preventive measures and realistic treatment choices. The lack of a fat checkbook or health insurance blocks access to simple, effective, preventive primary care and forces the uninsured to use the most expensive venues for care: crowded emergency rooms where there's no possibility for continuity and follow-up. It's an upside down and unnecessarily costly system created by the fact that we just don't think access to health care should be a fundamental right for everyone. Our community hospitals are suffering financially because of this broken system, but worse—our neighbors are dying because of it.

Until these changes come to pass, I believe that demand for my services will keep growing.

Laura Weil, head of Sarah Lawrence College's master's degree program in health advocacy, has been a patient advocate for 20 years. In 1980, Yonkers-based Sarah Lawrence established the nation's first and, to date, only master's program in health advocacy.