Houston doctor discusses how to fix the healthcare system for the uninsured

Monica StanlyMarch 15, 2023

In the United States, the cost of healthcare can be a huge source of stress – an illness or an unexpected medical bill can throw a person’s finances into disarray. This is especially true here in Texas, which has the largest number of uninsured people in the country.

This is a complex issue that legislators have tried to solve in different ways, and have found many common ground. But there may be an example in Houston that could point the way forward.

Dr. Ricardo Nuila, a professor at Baylor College of Medicine, draws on his experience at Ben Taub Hospital in Houston in his new book. The People’s Hospital: Hope and Danger in American Medicine. He joined Standard to talk about what he learned while working at the medical center. Listen to the story above or read the transcript below.

This transcript has been lightly edited for clarity: Texas Standard: You know, it’s probably best to start with Ben Taub. For those who are familiar, tell us a little about Ben Taub.

Dr. Ricardo Nuila: Ben Taub is a public hospital in Houston, Texas. It’s funded by taxpayers in Harris County and it’s a social safety net hospital so people can go to it even if they don’t have health insurance. It is also a teaching hospital for the Baylor College of Medicine.

Is it really unique in Texas or other parts of the country, for that matter? I mean, how would you place it there?

There are other similar hospitals, such as Parkland Memorial Hospital, and there are other medical institutions – social security systems – in the state, for example, in San Antonio and El Paso. What is characteristic of Ben Taub is that he originated from a hospital called Jefferson Davis Hospital, and it was the voters’ initiative – the referendum – that allowed Ben Taub to become the city’s public health system.

So, to what extent did your experience at Ben Taub influence your decision to write this book and what you write about in it?

Well, I think it’s an integral part of the book. I started writing about healthcare. I didn’t know how. And at the time when I was a medical student and a resident, everyone around me said: “Someone should write a book about Ben.” I had no idea how it would happen, but I had to think a lot about it. I had to think about the patients I encountered and their stories. And it took a lot of time to think about the structure of the book, to translate those stories into the ideas that are presented in the book.

But when Ben Taub’s mission is pretty much a sort of last resort for many patients – and I think he does a lot of triage – is it a model for other healthcare providers in the future? And to what extent will it be?

I think the original concept was that it would be triage, but what grew out of that is a model because to prevent more and more triage, the system decided to put primary health care clinics in the city. And this has been going on for several decades. And so the model is to have a healthcare system so people don’t have to rely on going to the emergency room. And this is his innovation.

We’re talking about a vision for healthcare that will rely heavily on some sort of public funding – not a non-profit per se, although I assume it will be a non-profit – but a publicly funded healthcare system built around some kind of model like you. ? re-describe?

Yes, I think that’s what Ben Taub can give in the health care debate is that it’s a publicly funded health care model and that means it’s directly distributed to people at the county level, which means instead passing through an intermediary – an intermediary such as insurance – medical care is provided directly to patients who need it. And this greatly reduces costs. Costs are a huge burden in healthcare and this is one of the reasons many people don’t have access to them. And so one of the things the book tries to do is to demonstrate what this direct aid does in terms of lowering the price of healthcare.

I think I see the argument for lowering the price, but as I’m sure you know, doctor, a lot of people think, “Well, Americans, when they can afford it, have the best healthcare in the world.” And you look at, for example, the National Health Service (NHS) in England, which, as you describe, is a publicly funded system, and you really have the elimination of these inefficiencies and these inequalities at the same level. But there is an argument that this also tends to act as a resistance to innovation What do you say to people who would like to draw comparisons to something like the National Health Service or social medicine?

Yes, I think a couple of points. First, I don’t necessarily think they are mutually exclusive. I think that the public health system could provide basic health care for everyone, and that the private system could still exist and perhaps even compete with the public health system for patients. Imagine a person who is 22 years old, he works and in our system right now must purchase health insurance. But perhaps if basic health care were available, then the private party would have to compete for that person’s business and perhaps lower costs to do so.

On the other hand, I think Americans don’t really realize how much waste is related to healthcare in general. And so we may think that most of the care we receive is necessary, but in fact, most of it is redundant. You can point to the antibiotics used, which are more expensive than other antibiotics that can be used. And so I think there’s no doubt that innovation is happening in the American system, and that’s a good thing. But I also think there are ways to cut down on that waste. And I think health care could be a good guide for that.

If you found the report above valuable, please consider making a donation to support it here. Your gift helps pay for everything you find on texasstandard.org and KUT.org. Thanks for your donation today.