KU Med's Allen Greiner has good medicine for a bad health-care system 

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In 2002, Greiner wrote a book review that appeared in Journal of the West, a literary magazine. Greiner commented on Quinine and Quarantine: Missouri Medicine Through the Years, a book by a surgeon and professor named Loren Humphrey.

The review was negative. Greiner thought the book made doctors seem too heroic.

"Its wandering themes return most often to the triumphs of the medical profession and scientific technologies," Greiner wrote. "This has the unfortunate effect of reducing three centuries of Missouri struggles with illness and disease to a formulated pat on the back for doctors, hospitals and researchers working in the last half of the 20th century."

A better book, Greiner went on, would have featured more stories of "osteopathic medicine, of women and minorities and of rural citizens."

Greiner continues to be suspicious of the power and authority vested in his profession. Modern medicine, he says, is in many ways a story of accidents, greed and selfishness.

"I would argue we all need to make less money," he says. "It's a little ridiculous to pay teachers almost nothing and pay physicians insane amounts of money."

Greiner believes that U.S. health-care costs could be cut in half if the right structures were put in place. His ideal system would put a premium on the most effective forms of care. It is relatively cheap, he notes, to treat high blood pressure and diabetes. Once the chronic illnesses were paid for, there would be plenty of money left to remove gallbladders and treat skin cancers. But experimental chemotherapy for people likely to die in six months? Greinercare can't afford it.

Not surprisingly, primary care physicians and public health workers are playing significant roles in this more efficient system. Greiner would like it if family doctors had time — that is, got paid — to communicate with patients via e-mail.

Of course, doctors are not the only ones who would have to accept change. Insurance companies, drug and device makers, and consumers would all have to put "skin in the game," as the saying goes.

"It just takes the willpower and everyone sort of feeling the pain of the change," Greiner says.

A grown-up discussion about controlling costs and expanding care seems unlikely in the current political environment, though. Large segments of the population lead difficult lives and have terrible health, Greiner says. Yet state lawmakers act as if they have it made. Greiner was appalled when Missouri instituted drug testing for welfare recipients.

"Do we not realize that if you're on welfare, your life really sucks already? And now we're going to go after these people and see if they're using drugs or not and yank their welfare benefits for three years? It's amazing how we think," he says.

Greiner is not retribution-minded. Rather, he's drawn to people who lead complicated lives, like the ex-con who likes to complain. And he continues to fit patient care into his increasingly busy schedule. Some of his patients have been with him from the time he was a resident. Greiner says he has a soft spot for the people of Kansas City, Kansas.

"To me, the worlds people live in there are interesting," he says. "And I know that they need a lot of help."

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