But everyone knows that the long-term debt problem is a health care problem, we spend far more on health care than we get back in outcomes, and cutting health care cost growth is the key. If we don’t, then we’re completely screwed no matter how much we cut Medicare–someone has to pay those health care costs, and if we cut entitlements we’re just shifting the problem onto individuals.–The Baseline Scenario

It is now an accepted  fact that Rep. John Murtha died of a medical error: he was undergoing “routine” laparoscopic gall bladder removal, which has been around for almost two decades, and a surgeon nicked an intestine. As a result, he developed an infection. In medical journals, there have been articles about the limits of laparoscopic gall bladder surgery.

All this happened at Bethesda Naval Hospital, the place where the members of Congress, with their “Cadillac” health plans, routinely go. He was not poor and uninsured, or part of “socialized medicine.” And yet, he died of complications from a “simple” surgery.

Let’s try to put this in a larger context, that of of the Great American Health Care Reform Debate Debacle. What conclusions can we draw?

Once again, I draw on my experience as the widow of a physician, his former “office manager,” and a long-time health care marketer.

1. Doctors make mistakes. They are human. No matter how much we pay them, they will continue to make mistakes. They feel terrible about them, they analyze them, but they continue to make them.

2. Hospitals are places where patients routinely suffer from infections — some preventable, some not. Medicare knows this, and has taken steps to stop paying for preventable incidents.

3. Accidents happen everywhere, from France to the U.S. to India, to Africa.  Above a certain baseline level, they’re not confined to “free markets” or government-sponsored health care.

4. Nor are accidents  confined to the poor,  at County Hospitals, or to those without insurance.

5. American physicians do care about their outcomes: after the Murtha incident, this week’s Medscape has a headline about “The Malpractice Risk When Your Hospitalized Patient Has a “Never” Event” (a “never” event is one that should never happen, and therefore is not paid for by Medicare or Medicaid and the patient’s family sues the doctor because they can’t pay the hospital bill). But they can’t predict them. That’s why they’re all so frightened of malpractice suits, and why their malpractice insurance is so high. Tort reform would help this, but won’t happen until we change our thinking about what health care should do.

So we, as Americans, have to change our expectations. We need to expect less from modern medicine. Yes, we can press for greater quality, but we have to recognize we’re not going to get immortality, no matter how much we pay.   We need to spend less, so that we align the outcomes with the expense, and the expectations with the realities.

That means every hospital may not get an MRI machine of its own, but perhaps one hospital in a municipality gets one, which means we as a nation pay less for every new medical technology.  RIght now, not only to hospitals all have MRI machines, but private partnerships also have them outside hospital settings. (My husband was a partner, with a group of other doctor-investors, in an MRI machine).

Or it means we  reimburse more for primary care, rather than for specialists. Or spend more on underlying process improvements (information technology, hand-washing training)  than on just paying providers (hospitals and physicians).

This kind of thought process, to me, is much more important than mere insurance reform. We have been taught to expect far too much out of our medical system, and to ignore its shortcomings or think we can fix them with more money, more technology, more whatever.

We spent a good deal of last year ranting about how Congress should be forced to buy the same insurance all Americans do. We didn’t pass any legislation, and Congress still has its fancy health plans. But is John Murtha still alive? No.

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