Now that the political tension surrounding health care reform in the United States has been somewhat dissipated by other concerns, it’s a good time to put forward proposals that could unblock the process, from an authentic perspective of respect for the human person. In the end, this is a matter of life and death for millions of people.
In order to contribute to this reflection from a Christian perspective, Aleteia interviewed someone who has spoken to both President Barack Obama and President Donald Trump.
The doctor in question is Dr. Ramon Tallaj, who won the “Doctor of the Year” award at St. Luke’s Roosevelt Hospital in New York and is the president of Advocate Community Providers (ACP) as well as of SOMOS Community Care, a network of more than 2,000 physicians, of whom 1,200 are doctors providing services to half a million patients in New York City.
In addition, Dr. Tallaj brings to the table a Christian perspective of medicine, which he has been able to develop in depth through years of work in leadership and support for assistance programs of the Archdiocese of New York—not only in the USA, but also abroad. For years, he has organized medical missions to the Dominican Republic, where he was born, as well as—more recently—to the islands of Puerto Rico and Cuba.
Ramon Tallaj shares with us three key considerations for creating a basis for the much-needed reform of the health care system, from a perspective in accord with profound respect for the dignity of each man and woman.
A change of mentality
Above all, there needs to be a change of mentality, “because it’s not possible for the reform to be carried out by people who don’t want the system to change,” the doctor said during our interview.
To explain, he offers two examples.
“On one hand,” he says, “there are the laboratories that produce medicines. Large companies in the pharmaceutical industry create a bad reputation for generic medicines, despite the fact that generic ones are just as effective. They’ve created a false belief that generic medicines aren’t worthwhile. But, if the health care system were to promote generic medicines, people could save 10% on their medicines.”
The other example the doctor mentions is the role that hospitals have assumed in financing the health care system.
“We have to overcome the idea that the health care system is based on isolated transactions: I attend you for a particular need, you pay me, and we don’t see each other any more. The patient should receive integral, holistic attention—dealing, consequently, with the problems of housing, work, transportation, family, etc.”
The systems used by hospitals or medical conglomerates to finance the admission of patients spend 25 percent of their budget without having seen a single patient. “This must change!” says Tallaj.
The central role of the family doctor
The second key element of this reform, therefore, requires re-centering the health care system on the primary care physician or family doctor.
“The art of medicine depends on creating an authentic bond between the doctor and his or her patient,” he explains. “The human element is of vital importance: listening actively to the person, taking interest in what he or she feels and suffers, showing compassion, empathy. These have been central elements of a doctor’s vocation since the very beginning.”
“This view of medicine requires providing doctors with the resources necessary for them to be the ones who control health care budgets, together with the institutions in charge of administrating the hospital admissions system, which until now was the decisive economic indicator of the health care system.”
Often, the hospital system, when it comes to distributing its millions of dollars of earnings, skips over the primary physician, Tallaj says. “This situation is dramatically contradictory, because some doctors, after years of formation, take the risk of opening an office in a poor community to attend those patients, sometimes in heroic circumstances. Those doctors are offering a great service to the country.”
“It’s necessary to work on training doctors so they can have the necessary resources to attend their patients,” insists Tallaj. “This makes it possible to save a great deal of money in the hospital admissions system. And it’s possible to do it by implementing a ‘pay-for-performance’ system (offering a bonus to doctors according to their results, with clear, shared objectives), which motivates physicians to improve patients’ health, and which acknowledges the excellence of their professional medical service to their community.”
Understanding the situation on the ground
Lastly, Dr. Tallaj offers a third key aspect for reforming the health care system: “In general, the people in charge in the health care sector have a great education from universities like Harvard, but they have never seen a patient under the Medicare or Medicaid programs (the federal health care programs in the USA). Consequently, they make decisions that have nothing to do with reality.”
The president of SOMOS Community Care offers a concrete example of the dysfunction resulting from that mentality:
“When the government says that a Medicaid patient must obligatorily pay $5 for a consultation, and the doctor must (I repeat, must) ask for that payment if he doesn’t want to break the law, we are creating an enormous problem.”
“Think, for example, of Jane Doe; she has $6 in her wallet, so she won’t go to the doctor,” he explains. “In this way, her problem will get worse, and she will only go to a hospital emergency room when her situation is desperate. In this way, preventative medicine fails, along with an integral health care system. I asked President Obama to eliminate that rule, because we—the doctors serving poor communities—can live without that money.”
Lastly, Dr. Tallaj didn’t want to end his comments without underlining a grave problem in the United States.
“Young people need to be aware that they should get health insurance while they are young, because we can all live until old age. We need to find balance in insurance companies, so that on one hand they can receive the legitimate profits of their activity, but on the other hand, the prices of insurance policies should be able to be adapted to the economic possibilities of the clients. Today, young people who earn $4,000 each month don’t want to pay $400, because that’s 10% of their salary, but insurance is necessary for an organic health care system. In the past, a proper mentality wasn’t created or conceived so that the greatest number of people would buy health insurance, and this has generated serious problems for creating a health care system in the United States that favors everyone.”