Transcript for the Piece Audio version of Why Single Payer, Part 5: The Flow of Medical Information, the legal system, and medical school.

MILES EDDY
We all value our privacy! But when we go to see the doctor, we want our physician to know everything relevant to take care of our health! Although the legal system is designed to protect us, it can sometimes be part of the problem regarding our healthcare. I'm Miles Eddy, and I spoke with Dr. Rocky White, Mr. Russ Johnson, and Dr. Beth Kinney about some of the challenges managing the flow of information in our health care system.

RUSS JOHNSON
In the last five years there's been a very strong push towards regulating the type of information and the format that information can go between parties so that we don't compromise anybody's personal healthcare information. How do we now sort that information, blind it, shift it back and forth between parties that have a need to know and should know, like your doctor or your specialist, without compromising your privacy. The challenge is making an incredible complex medical record that may have visual data, graphic data, numerical data, so converting all of that information into some kind of standardized format; so what sounds like ought to be a very simple thing ultimately becomes a very complicated thing.

MILES
You must use computers and technology quite a bit in the ER?

DR KINNEY
Actually we use it less than you might image.

MILES
A lot of people come in with a medical history. How do you have access to that?

DR KINNEY
Right now we do not. We have access to their old charts, if we can find them.

MILES
But that's only if they came back to the same hospital?

DR KINNEY
That's correct. We do not have access to their primary doctors records. Many of the private physicians in the valley do have their patient's medical records on computer. But we in the ER don't have access to those records. Putting everything on computer kind of adds new dimensions to how complicated protecting peoples privacy will be. Often times we have to rely on the patient for their medical history, and I do believe that patients have been trained, unfortunately in our country, to be very passive with their healthcare. Many people I'll ask "do you have high cholesterol?", "No I don't" and then when you get to their med lists you see that their on medicine for cholesterol, and I say "well your taking medicine for cholesterol", "Yes it's under control now." They don't understand that, yes, you have high cholesterol, the medicine is keeping it under control, but from my perspective you still have this diagnosis.

DR WHITE
The legal system: The stand in Washington is this; "if we could just get tort reform, if we could just stick it to those attorneys and put caps on malpractice, we could fix the healthcare crises." Less than one percent of our total healthcare spending goes towards malpractice. However, what it doesn't take into account is what I call C.Y.A. medicine, or Cover Your Ass medicine, because one of the things that doesn't get taken into account is how many test I have to order as a doctor when I know they're going to come back negative, but if I don't order the test and it does end up becoming a problem, I get sued.

DR KINNEY
Medical school doesn't teach you how to deal with being sued. It's a devastating experience. It's not something anyone wants to live through, and people go to great lengths to try and avoid it, and that?s what happens. Many of my class mates graduated from Medical school over $100,000 in debt, they went and finished residency and then had to do some specialty training so that they could make big bucks to pay off their medical school loans and they were bitter about it.

RUSS JOHNSON
We have physicians coming out of school not with $100,000 of debt but some of them $150,000 or almost $200,000 of debt, and what that's done, it's kept physicians from being able to set up private practice. What that kind of a debt load, those physicians just can't do that.

DR KINNEY
There are program now, in fact many of the doc's at Valley Wide go through programs where they come to what they call a healthcare manpower shortage area, the federal government will pay off their student loans at a certain X amount of money per year, and that's how CHC's (Community Health Centers) throughout the country attract physicians.

MILES
Do you think a single payer healthcare system will help that in any way?

RUSS JOHNSON
I guess my answer is yes, indirectly. I think what a single payer health system will do is that it will make it more realistic for a physician to practice medicine regardless of where he or she wants to live. So the physician coming out of medical school and wants to be independent, doesn't want to work for the hospital or for another organization, can do that because they weren't having to eliminate Medicaid and indigent people from their practice. They could still see those people, see enough volume to have a reasonable, competitive income for a physician and pay off their loans. So I think indirectly it would have a benefit.

MILES
Next time, we'll conclude our discussion with Russ Johnson, Dr. Beth Kinney, and Dr. Rocky White with an idea that Colorado is considering to address some of the problems in our healthcare system. Reporting from Alamosa, Colorado, and produced in the studios of Midi Age Productions, I'm Miles Eddy.