Sunday, February 21, 2010

Do-or-Die - Health summit -Health Reform Olympics

It has finally come to this. After a year of partisan debate, President Obama, last year’s gold medalist and his Republican rivals , will meet at the top of the mountain on February 25 in the White House to decide who receives the medals in this year’s winter political Olympics.

No clear favorite exists, even though President Obama will have the high ground as moderator of the event. What he will not have, however, is the majority of the American people on his side. Only one-third approve of Obamacare, and they are angry and frustrated about jobs, spending, and deficits as well. After Senator Scott Brown's Massachusetts election,Republicans are riding a rising conservative tide.

President Obama claims broad areas of agreement exist on such matters as insuring those with pre-existing illness, but he remains adamant any compromise must simultaneously be comprehensive and must cover 30 million more Americans. He insists all of this must be accompanied by cuts in Medicare costs.

Such a compromise is politically unachievable , say Republicans. Finding the solution, Republicans assert, must start from scratch, must be incremental, and must be based on market-driven solutions - shopping across state lines, giving consumers choice, offering health savings accounts, providing tax credits for individuals as well as corporate employees, widening access through larger insurance pools, and reducing costs through tort reform. That doesn’t leave much room for big government – Obama’s preferred solution.

How should PresidentObama and his opponents prepare for this winter’s political Olympic event? Both are in deep training and both have carefully-honed strategic agendas.

A good start would be to read In Their Own Words; 12,000 Physicians Reveal Their Thoughts on Medical Practice in America (Morgan James Publishing, 2010).

The book is a quick read. It is only 143 pages. It is written by Philip Miller of Merritt Hawkins & Associates, the largest U.S. recruiting firm, and Lou Goodman and Tim Norbeck of the Physicians Foundation, which represents physicians in America’s state and local medical societies.

The book is based on a survey of 270,000 primary care doctors and 50,000 specialists closely engaged in primary care. Of doctors surveyed, 82% said their practices would not be sustainable if Medicare reimbursements to physician were further cut, 38% said if cuts occurred they would stop seeing Medicare patients altogether or reduce the number of Medicare patients they see, and 60% remained opposed to a single payer model. They preferred a market-based model.

Whatever compromise Obama et al might hammer out, I suggest, after they read the book, they ask themselves: Who is going to take care of Americans once the solution is reached?

Due to a rising and aging population , caps on the number of medical students and graduate programs, and changes in physician expectations, the U.S, faces a shortage of 200,000 doctors by 2025. The Lewin Group says Obamacare, if enacted, would require 14,500 more doctors, and universal coverage would require an additional 35,000 more doctors.

Presently, foreign-trained physicians are plugging the dike: 25% of practicing physicians in the U.S. and 50% of doctors in primary care training programs are international graduates.

This is not necessary nor desirable. Many bright Americans who would like to become doctors , and many citizens would welcome American doctors into their communities.

Health reform is not only about insurance coverage. It’s about access to doctors too. When we get sick, most of us will want a doctor in the house.


Michael Kirsch, M.D. said...

Richard, the Health Care Summit Follies will occur this Thursday. The health care situation will be the same on Friday.

Richard L. Reece, MD said...

Michael, you may get your best jollies,

By calling it the health reform follies,

But for Obama this is a serious summit,

Though his poll numbers may plummet,

It’s definitely one of his final volleys.

Michael Kirsch, M.D. said...

On Thurs we’ll hear from ‘the Man’
As he teleprompts on C-span
He’ll be short on facts
And long on tax
And dismissive of GOP plans!

Richard, I respectfully invite you to 'Grand Rounds' at