Saturday, August 7, 2010

The Time Has Come, the Doctors Said, to Talk of Reform Myths, Why the Political Sea is Boiling Hot, and Why Pigs May Have Wings

The time has come," the Walrus said,
"To talk of many things:
Of shoes--and ships--and sealing-wax--
Of cabbages--and kings--
And why the sea is boiling hot--
And whether pigs have wings."

Through the Looking Glass and What Alice Found There, 1872

A lot of health reform myths are floating around out there that have an Alice In Wonderland feel to them. These myths include what doctors think about the health system and efforts to reform it through the new health law.

American doctors, for good reasons, tend to think we have the best trained doctors, the best hospitals, and the best research in the world. Doctors from abroad, after all, flock to our shores for advanced training.

But we doctors are realists, and we don’t necessarily believe our clinical excellence in caring for the sick translates into the best health system in the world. We may have the best sick care, but we do not always have the best overall or most cost-effective care.

We know our system is riddled with imperfections, often due to factors beyond our control, such as financial barriers to access, an adversarial legal system, and burdensome administrative hassles.

The system is fragmented. We do not train enough primary care doctors or reward them appropriately. Too many of our citizens remain uncovered. Too many medical bankruptcies occur. Federal and private bureaucracies stifle practices and snuff out innovation by taking time away from patients to fill out forms or ask permission to perform procedures. Too much time and money is wasted on administration.

Tax deductability of health costs should be extended to all citizens. We should expand tax-protected health savings accounts, and let citizens pay for more of their own care of their own choosing.

We agree with some of journalist T.R. Reid’s observations. He wrote “5 myths about Health Care around the World.” These 5 myths included:

1. It’s all socialized medicine out there.

2. Overseas, care is rationed through limited choices or long lines.

3. Foreign health-care systems are inefficient, bloated bureaucracies.

4. Health insurance has to be cruel.

5. America has "the finest health care" in the world.

Some of these may be myths. There are efficient national systems out there that rely on private care. On the latter point, however, in many respects, we do have superb care, especially if you are sick and need access to the best curative and life style restorative care the world has to offer.

But in other respects, universal coverage, financial equity, affordability, and statistical health outcomes, we may fall short of other nations.

Still, we feel it is a mistake, and often downright misleading, to compare us statistically to other nations. Our health system is a creature of our pluralistic culture, its desire for individualism, and its preference for a mix of market-driven and government driven care.

And, if I may be blunt, doctors are deeply skeptical and downright negative about the mythological promises of health reform.

These include:

1. If you are satisfied with your existing plan, you can keep it. This is a myth. When time comes to change plans, your plan must meet federal standards, or you will have to go with a federally approved plan.

2. Reform will lower health spending. Another myth, one with which evens the OMB disagrees.

3. Reform will lower health premiums. This myth has already been discredited, as health plans struggle to remain profitable while meeting new reform standards.

4. Reform will not lead to doctor shortages, or speed up primary care
shortfalls. Reform does not encourage education of more doctors, equitable pay of those now practicing, or lessening of expenses required to meet new regulations.

5. There will be no government rationing of medical care. In the face of $575 billion cuts in Medicare, the push for comparative research as a criteria for payment, and the appointment of Doctor Donald Berwick as head of CMS, this myth simply does not ring true.

6. Ninety five percent of Americans will not see any form of tax increase. Never in the history of the Republic has expansion of “free “entitlement programs not required general tax increases.

7. Reform will not add a “single dime “to the deficit. Hold on to your wallets and those of your children.

8. Reform will help businesses. Businesses have not yet gotten the message. They fear expenses of reform and the mandates that will be imposed upon them, which is why they are reluctant to hire.

9. Adding 30 million newly insured patients to current heavy patient loads, with the addition of electronic health records, which decrease productivity by 30%, will somehow simultaneously improve care, decrease errors, and enhance communication between doctors, patients, hospitals, and payers.

10. Reform will satisfy everybody with no downsides. Why, then, do 60% of Americans oppose reform and 56% advocate Repeal and Replacement? Voters in November will show how many Americans are satisfied and how many see downsides.

To conclude, the time has come to talk of pro-market, U.S. style reform antidotes - health insurance vouchers, malpractice reform, universal tax-free health savings accounts, and indiviudal portable medical plans across state lines.

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