Saturday, October 3, 2009

Doctors Weigh In On Reform

Preface: On October 3, From Grace Marie Turner, founder and president of the Galen Institute, comes this message. It is pointed and poignant. Denis Cortese, M.D., CEO of Mayo, says; why not create a national package of insurance options modeled after the Federal Employees Health Benefits Plan, the plan Senators and and Congressmen have enjoyed for nearly 50 years. His counterpart, Toby Cosgrove, MD, of the Cleveland Clinic says somehow we’re got to integrate hospitals and doctors to make practice more efficient . Otherwise the burden of disease in a aging population coupled with technology advances will drive "costs into the sky.

"The White House has invited scores of doctors to join the president on Monday for a very visible push for health reform. But his plan is just not selling in the rest of the country. Most doctors do understand that turning so much power and control over health care to Washington will mean they have even less authority than they do now to make the best decisions about their patients' medical care."

"Two of the nation's top docs weighed in this week:

• "Denis Cortese, chief executive of the Mayo Clinic, told The New York Times it is "heartbreaking to watch" the current machinations in Washington over how to overhaul the nation's health care system.

According to the Times: Dr. Cortese argues that Congress has become too enmeshed in the details -- discussing what the benefit package in a health plan should look like, for example."

"In his view, Congress already micromanages the Medicare program and has proven itself unable to withstand the political pressure and blandishments of lobbyists. "All of us are paying for it," he said, noting the spiraling costs of the Medicare program and its lack of emphasis on high quality care. Because Dr. Cortese contends that Medicare has had such a poor track record, he has not been shy in opposing a government-run health care plan, or public option, which many liberal Democrats favor. Instead, he would urge Congress to create a national package of health insurance options modeled after the Federal Employees Health Benefits plan."

• "Delos 'Toby' Cosgrove, chief executive and president of the Cleveland Clinic, said health costs will continue to escalate unless Congress goes beyond the reform measures it is considering now, CBS News reports. At a conference in Washington, D.C., Cosgrove explained that insurance and payment reform are not enough. "It is essential, he said to also implement changes to the delivery of care, as well as to decrease the burden of disease in the United States."

"The number of elderly people in the U.S. is increasing, while the number of sophisticated treatments available increases as well -- both bringing costs up. "Add to that the situation where we maybe bring another 40 million people under coverage, you're going to see a continuing escalation of health care we're not going to be able to sustain at the present time," Cosgrove said. "We've got to figure out a way to do it more efficiently -- that's going to require doctors to be integrated with hospitals, and hospitals to be integrated with hospitals."

Dr. Richard Reece is author, blogger, speaker, and reform expert. Dr. Reece’s latest book, Obama, Doctors, and Health Reform ( is available at,, and for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For information on speaking fees and arrangements, call 860-395-1501.


Terence Coughlin said...

"Heartbreaking to watch", that's understatement.

On the idea of better integration between doctors and hospitals, beyond having physicians employed by hospitals, I am curious as to your opinions on what realistic opportunities exist for cost savings through integrated approaches. Bundled payments seems like a firestorm on the horizon if it ever gets serious...can physicians and hospital leaders sit at the same table and agree on anything substantial, or is this just pie in the sky thinking?

Richard L. Reece, MD said...

I can only cite my own experiences. As Chairman of a PHO, my president and I were able to put together 150 bundled procedures for common hospital admissions. We asked the hospital for a 10% discount and the doctors for a 3% discount. Yes, hospitals and doctors can sit at the same table and put together mutual acceptable bundles. So it is not pie in the sky. In our case, the deal fell apart because the Blues did not want to deal with a combined entity of doctors and hospitals. The Blues preferred to negotiate separately with doctors and hospitals. Bundling won;t work unless health plans buy in.