Saturday, December 22, 2012


The Quest for Physician-Patient Led Alternatives: Another Voice - An Interview with Hal Scherz. MD
You can always trust the United States to do the right thing,  once every possible alternative has been exhausted.
Winston Churchill (1874-1965)
December 22, 2012
Preface: Hal Scherz, 57, is a pediatric urologist in Atlanta.   He serves as vice-president of   finance for Georgia Urologists,  the largest group of urologists in Georgia,  with $75 million in revenues.   In 2009,  he founded Doctors for Patient Care (docs4patientcare.com),and serves as its president.  It  now has 3000 members and chapters in 14 states.
What are the alternatives to Obamacare? What is the right thing for physicians and patients to do?
I think the right thing for doctors to do is to uphold the Hippocratic Oath, to take care of patients and do no harm. What we are being asked to do today is to turn our backs on  our patients and abrogate our responsibilities that we swore to fulfill. 
Doctors have to make a decision as to what’s important in the future – the continuation of the Hippocratic Oath , or to do what Galen,  a contemporary of Hippocrates, advocated,  do what’s best for society. Modern society has chosen the former – to do what’s best for patients – so that’s what we have to do as doctors.
As I understand it, you wear three hats. 
One, you are an extremely busy pediatric urologist. 
Two, you’re the vice-president of finance for Georgia Urologists.
Three, you founded Doctors for Patient Care and serve as its president. 
What motivated you to found Doctors for Patient Care? What is its status now?
Doctors for Patient Care is a physician advocacy organization.  In 2008, the handwriting was on the wall as far as American medicine was concerned.  The position then-Senator Obama was taking in his run for the White House was that American health care was going to undergo a drastic change and that was government control.  Unfortunately that has come to fruition.
What were you doing at that point?
Up until then I was extremely busy in my practice. I still am.  I had not been active in medical, state, or national politics.  I was busy in my practice and in medical academics. I made excuses to not being politically active – the mindset of most physicians in this country.   As a result,  as physicians,  we’ve been left without a voice and very little leverage. 
When health care became a major issue at the end of 2008 and the start of 2009,   I discovered there was no avenue for physician advocacy that satisfied me or that was effective.   I thought we could turn back the government tide if enough physicians and patients were to voice their opposition just as they did with the immigration amnesty bill that preceded it two years earlier when the flooded the White House switchboards with objections.
What did you think was needed to turn the tide?
We needed an organization of physicians and patients to sound the alarm.  I spoke with a good friend of mine,  Doctor Tom Price,  an orthopedic surgeon  and a Republican Congressman from Georgia.  Tom urged me to start my own advocacy group.  At the same time,  people on talk radio and elsewhere were saying, “Where are the doctors? What do they think?” And bad things were being said, like doctors are cutting off legs just to make more money or taking out tonsils instead of treating a sore throat. There was no rebuttal.
So you founded Doctors for Patient Care?
Yes, we started in 2009 with 40 doctors with the help of Congressman Price.  Shortly thereafter talk radio, media people, and policy people, like the Heritage Foundation and health care think tanks around the country, jumped on board. We soon had hundreds then thousands of doctor members.  We grew in stature and began taking frequent trips to Washington,  to offer advice,  and to make our mission clear and to tell Congressmen and Senators what was at stake and what the issues were.  We built a footprint for Doctors for Patient Care. We are, after all, in  the clinical trenches and know what patients need and want. 
Meanwhile, our chapters in 14 states began to have influence in state policy matters.
As you know,  there is a growing resistance movement to implementing Obamacare, among physicians, businesses, patient groups, and state governors and legislatures. most of whom are listed on your web site.   As an example,  32 states have declined to set up health exchanges. 
Where do we go from here?
Even if Obamacare were to be fully implemented, I believe it  will collapse under the weight of bureaucracy. It is simply unworkable.  This law calls for 159 new agencies and bureaus and departments with thousands of new bureaucrats that will be doing nothing but administrating health care. 
We have seen this before –attempting to regulate all physician and patient behavior and transactions, and it has failed every single time. It’s being attempted on  such a massive scale everybody  knows how it can’t  possibly be done, even with the best of intentions.   It’s a Rube Goldberg scheme that’s been put together in a piecemeal  harum scarum fashion by special interests who got what they wanted to get it passed without regard to the consequences. 
Just last week we saw 14 Democratic senators lobbying to get rid of the 2.3% tax on the profits of medical device companies, which is killing innovation and employment in their states.   That 32 states have decided not to implement health exchanges is another sign of failure.  The federal government does not have the infrastructure or expertise to implement health exchanges in 32 states.
There’s another factor as well – excessive costs.  Wall Street analysts this week  predicted that health care premiums in 2013  will spike to 20% to 30% for the average family.   At some point, the public will revolt but how.
There are two schools of thought. 
One, that Obamacare will collapse with widespread  loss of access to doctors and hospitals and people will turn to private alternatives to continue to  get high quality care.
Two,  that Obamacare is such a mess by turning health care on its head that President Obama will have to ride in on his White Horse to fix the problem  by offering the Holy Grail – a single payer system.
Do you feel you’re making progress in uniting the public against Obamacare,  or modifying it in such a way to make it workable?
Well, progress is slow.  As you know,  physicians are difficult to mobilize, hence, the expression “Organizing physicians is like herding cats” 
Another problem is apathy,  a  feeling of helplessness, that nothing can be done to slay the federal beast or even  to bring it  to its  knees. 
Doctors have been told they are not good at politics or business,  so why struggle or even try.  Many doctors have given up and sold their practices to hospitals. 
The Wall Street Journal reported a couple of years ago,  that more than 50% of practices are owned by hospitals or other entities. Doctors are giving up by going to work for others.
What are you trying to do to reverse these trends?
We’re trying to give doctors help so they don’t need to give up.  And if they do give up,  to convince them that will be giving up everything they became a doctor to be, and their patients will be the losers.
When you have a top-down system when government administrators,  not doctors and patients, decide what kind of care individual patients are getting, the ultimate losers are everybody.
So what’s the alternative?  Is it political?  Is it organizational? Is it massive public protests over not being able to find a doctor – or to afford a doctor?
I think it’s all of the above. 
It’s in part political.  I give President Obamacare credit.   He has put health care out there as a topic we should focus on.  But I disagree with his philosophy.  I think the government should be a watchdog,  over a free-market system of health care.   It should not be a government police dog sniffing to see every transaction meets federal standards.
At the end of the day,  patients should be the ones making their health care decisions,  not government.  And they should do so with the doctor as their trusted advisor, not a government bureaucrat saving money for the system through an accountable care organization or some other government entity.
What is the solution?
The solution is: patients need to be in charge of getting their own health care insurance as a hedge against a catastrophic event  rather than a pre-paid health care plan paying for everything.
People need to have “ skin in the game”, to be in charge of paying for their own health care insurance.
Health care needs tobe  more affordable.  For that to occur,  there needs to a free-market  for  purchase of insurance
Insurance needs to be purchased in an open marketplace over the Internet so companies can compete for consumers’ business.
Insurance needs to be decoupled from the workplace.  People often stay in jobs because that’s where they get their health insurance. 
That should not be.  A patient should own their own policies which should be portable from job to job and from state to state.
As it now stands,  health insurance benefits the employer who can deduct the costs of health benefits, something others cannot do.    Everyone , including the self-employed, should have deductible benefits.
We should encourage patients to become consumers and to not expect their insurance to cover everything.  In order to do that, and to give them skin in the game, we need to encourage patients to purchase high deductible savings accounts so they can start pricing health care services,  which ought to be transparent on the Internet.  Physicians and hospitals should be required to post their fees.  Those fees ought not be controlled by an arbitrary third party, like government or a health plan.
What there also needs to be in this re-worked health system is serious tort reform.   The amount of money spent on defensive medicine ranges from $200 billion to $600 billion.  Reform the tort system
 And the costs of health care would tumble.
In essence, those are the pillars of a rationale, affordable health system.  Those are the concepts physician organizations need to rally behind.  If patients were allowed to privately contract with their physicians based on these principles,  it would fix the system in a few years.

 

 

 

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