Sunday, June 6, 2010

Moving Doctors Front and Center in Reform Debate: Redirecting and Correcting the Health Care Follies

In the last three years, I have written two books and 1348 blogs on health reform and innovation.


Because I believe reform, American style vs. European style, is necessary. And because I believe American ingenuity is the best path out of the cost morass.

It’s my ambition to redirect the health care debate - towards innovation, and towards doctors and patients and away from government control, administrative concerns, and third parties interventions.

The health system should focus on doctors who deliver the care and patients who receive it. Everything else is ideological sound and fury. So far the health debate has marginalized the 650,000 doctors who provide care. The debate has yet to impact what takes place on the ground. Ditto for 250 million insured patients who receive care. Government reformers, policy wonks, and members of the health care industry and their lobbyists have dominated the debate proceedings . They have left practicing doctors and paying patients out in the cold. Doctors face declining reimbursements and more 3rd parties telling them to how to practice medicine, and patients will face less access to doctors and to technologies, and higher premiums, higher costs, and higher taxes.


What do doctors and patients want?

• Doctors want assurances that they will be paid enough to meet their expenses, they will be freed from paperwork so they will have more time to see patients, and they will be relieved from the constant anxiety and expense of a toxic, litigious, malpractice environment.

• Patients want assurances that they can afford care, they can trust their doctor to provide the right care, and they can have reasonable access to the best medicine has to offer,; They want these things without second guessing by remote and privacy intrusion s by federal and health plan bureaucrats .

Assurances Not Forthcoming

Instead Congress has dithered again on tort reform and on fixing the Sustainable Growth Rate (SGR) formula.

Here is how The New York Times sees the SGR fix problem in its lead editorial today,“The Doctor Payment Follies,” June 6, 2101).

“The formula that is used to pay doctors who treat Medicare patients is producing increasingly absurd results. If it were to be followed this year, doctors would face a 21 percent cut in payments for the tests, procedures, office visits and other services they provide to elderly Americans.”

“That would be a disaster, driving many doctors to stop accepting Medicare patients. Luckily, nobody is seriously contemplating that. As it has done repeatedly in recent years, Congress is readying a short-term fix that would provide a modest increase in physician fees for the next 19 months. “

“There will likely be no real solution until the American health care system moves away from unfettered fee-for-service payments that encourage doctors to perform unnecessary and costly tests and procedures and pays them instead for better management of a patient’s care over time."

The U.S. vs Other Nations

And here is how the Times sees health costs problems of American Medicine compared to other nations,

“Doctors visits, medical procedures and prescription drugs cost vastly more in the United States than other countries.”

The Times quotes Coleen Grogan, a professor of health administration policy at the University of Chicago, who says,

“We have known for a long time that health care is a market failure,"
(Hanna Fairfield, “Health Spending vs Results,” NYT, June 6, 2010).

A Market Failure?

Of health care being a market failure, I am not so sure – it has never really been tried. Americans pay an average 12% of their health care bills, and Congress is trying its best to discourage use of health savings accounts, in which patients pay a high deductible and save the rest for a rainy day. For consumers, the economic incentives are for more care and for doctors to provide it.

What Congress never talks about that health systems account for only about 15% of a nation’s health. The other 85% can be attributed to socioeconomic conditions, poverty, family unity, immigration patterns with ethic mix, and violence and accident rates – most beyond the health system’s reach.

The Congress also never addresses the customer’s demand and expectation for certain procedures as an expected standard of care in the U.S. – CT scanners per million people(34.3 in the U.S. vs 12.7 in Canada and 56.0 in Australia, Angioplasty procedures per 100,000 people 437 in the U>S., vs 192 in France and 560 in Germany.

Health spending, its nation’s health, and its longevity are functions of a nation’s culture, not necessarily its health system. What we need to do to move the health debate forward reality is more frank talk about the individualism of U.S. culture and economic, psychological, and legal demands on doctors, and less glib answers such as “moving away from an unfettered fee-for-service system.”

1 comment:

Alex Easton said...

I agree patients/customers should be front and center. I would add a slight modification that "clinicians" should be front and center also. Doctors are just one piece of the clinical team.