Sunday, November 14, 2010

The Health Reform Storm

November 14 - Recently, on November 9 to be precise, I wrote a well-received blog about America medicine’s exceptionalism.

I cited the excellence of our academic centers, our mastery of the English language, and our dominance as Internet innovators.

Part of my blog rested on my experience as a member of the Board of Advisors of Castle Connolly Medical Ltd, a New York City company that, among other things, picks the nation’s top doctors and publicizes their achievements in regional magazines and newspapers. Just yesterday, Castle Connolly ran two full page ads in the New York Times featuring 64 top doctors in the New York City region. Doctors did not pay for the ad. The hospitals on which the doctors served on their medical staffs did. This ad was positive in that hospitals were using their marketing power to advertise the merits of their medical staff members, something doctors are reluctant to do for themselves.

Accentuate the Positive

In writing the blog, I thought it was time to be optimistic, to cite our accomplishments and the excellence of our system, rather than to feel defensive social factors beyond our control – the uninsured, lack of social services, drug and substance abuse, domestic violence, infant mortality, and poverty.

These factors drive up costs, but occur outside doctors’ offices and hospitals. Although it is not politically correct to say so, reforming our health care system also involves reforming our culture. This is not easy in a country that cherishes individualism, choice of doctors and hospitals, and demand to access to high tech medicine.

Instead, it was time to stress the positives of American medicine - our high survival rates for chronic disease, our plunging death rates for health disease and stroke, our life saving and life style changing technologies.

It was time to note that 85% of patients are satisfied with their current health plans, and most are pleased with their doctors.

The Coming Reform Storm and the Present Situation

Congress is now in the lull before the real health reform storm. The debate will involve hand-to-hand combat, it will not be pretty, and it is unlikely either party will give much ground.

Tomorrow the lame duck Congress goes into session. The newly elected House members are sworn in. White House, Senate, and House leaders will begin to strategize in earnest on how to defend or repeal the health reform law at the start of the New Year.

The setting for the coming Great Debate is familiar to everyone . Democrats lost 61 seats in the House and six seats in the Senate. More Americans opposed the health care overhaul than supported it. Exit polls indicated health care repeal was the second-most important issue for voters, after jobs and the economy.

A Kaiser Family Foundation Health Tracking Poll released the week following the election reported that just 25 percent of respondents believed they and their families would be better off under the law. Democratic candidates spent more than three times as much touting their opposition to the law as advertising their support. Republican Governor victories at the state level will make implementing the law more difficult.

Under these circumstances, what can physicians do to make themselves more respected and more prominent players in the health care debate, and to make the system better?

Here are a few suggestions.
• Pound on the theme that America has the most exceptional health system in the world, the best acute care, the most advanced technologies, the highest cure rates among those with chronic and rare diseases, and the quickest access to high tech care.

• Point out the world looks to the U.S. for medical leadership and innovation. That is why doctors from around the world come to the U.S. for advanced training, and why patients come here for treatment.


• Take pride in the fact that our entrepreneurial market-driven system offers freedom of choice between government and private sources of care and produces greater quality of care with greater amenities. We should be proud we are a free-market , center-right nation that attracts immigrants and doctors from around the world.

• Stress the realities and magnitude of the doctor and hospital bed shortage. We have fewer doctors per capita and few hospital beds per capita than any other developed nations, and a greater and growing shortage of primary care physicians. The addition of millions of more citizens under federal entitlement programs could easily overwhelm our system , produce long waiting lines, and create an access crisis.

• Show imagination by initiating by supporting and participating in programs that correct deficiencies of our current health system. These deficiencies include plugging “holes” in our social safety net, recruiting college volunteers to help needy families find access to food stamps, housing, medical transportation, medical mentoring, and job training. The Physicians Foundation, a nonprofit physician organization, is leading the way by issuing a funding grant to Project Health, a nonprofit that has mobilized college volunteers to serve at Help Desks in pediatric settings to offer help to families of sick children in seven major cities.

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Michael Kirsch, M.D. said...

Yes, a storm is coming, and I welcome it. The health care reform maelstrom is as much about politics as it is about health. I kindly invite you to my current post at bit.ly/94OHAb

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