Wednesday, July 14, 2010

On Resetting the Physician Reform Agenda: Obamacare in Perspective

The Obama administration has done a good job resetting and explaining its agendas towards international and domestic affairs.

On international affairs, it promises be less imperialistic, less jingoistic, more self-effacing and more modest.

In domestic affairs, it says it will be more “redistributive” with taxes and health benefits, evening out class differences.

On reform issues, the medical profession has been less effective explaining its position. Too often , we come across as too protective of our incomes and our jurisdictional privileges.

This is too bad. We have good stories to tell of our profession, of how our profession has improved care and outcomes, of why the American health system stands out among other nations, and how we can protect and extend the benefits of what we have to offer.

Among these stories are the following.

• As a profession, we are overwhelming for affordable universal coverage.
Somehow in the raucous health debate this has been overlooked. We are for extension of benefits to 32 million Americans, and for covering children, those who cannot afford to pay, those with pre-existing illness, and those up to 26 under their parents’ plans.

• As a profession, we are proud of our accomplishments
in treating heart disease, hypertension, diabetes, cancer, and other chronic diseases, and in developing technologies to save lives and to restore Americans to full-function.

As a profession, we are proud of our training programs and our medical research, which are the wonders of the world and which draw health care patients from around the world for treatment and health care professionals from other nations for advanced training.

As a profession, we know that nothing brings you closer to the realities of the imperfections of our system than being a physician. Among these imperfections are third party administrative costs in the order of 15 to 20% of all costs, a “toxic” litigious legal system that may account for 10% of costs due to defensive medicine practices , a pervasive mindset that says managers, technocrats, and politicians, all far removed from care sites, know best how to save money and improve care, and the belief that thousands of rules, such as 130,000 pages of Medicare regulations, will somehow cut costs and set things right.

As a profession, we are aware that the American health system is a creature of our culture – its affluence, its wants, its expectations, its behaviors, and its desires for the very best Medicine has to offer. Individual freedom, the American way, has its downsides. Among these freedoms are the freedom to live, eat, exercise, behave, have access to technologies in a diverse market-driven capitalistic society.

• As a profession, we are skeptical that a coercive government-centered system controlling all options and promising universal coverage is the only way to go. We need look no further than Massachusetts universal plan, now four years old. In Massachusetts, health premiums are the highest in the land, waiting times to see doctors are the longest, and legislation is in the works to make accepting Medicare and Medicaid patients a condition for medical licensure. Massachusetts is also the ideological home and residence of many of the leaders and drivers of health reform – President Obama, president advisor, David Cutler, Obama's chief advisor, Robert Blumenthal, MD, Obama’s HITECH czar, and Donald Berwick, MD , the newly appointed head of CMS, It is a legitimate question to ask: If health reform, Obama-style, doesn’t work in Massachusetts, will it work elsewhere?

As a profession, we wonder if a universal system of obligatory, government-imposed, interoperable electronic records is worth the estimated price of $27 billion over the ten years. The government has just announced its conditions of “meaningful use” of EHRs, which will require doctors meeting 25 and hospitals 23 conditions for “meaningful use” by 2015, or else, or else being excluded or penalized if EHRs are not adopted and made operable by said date. Given that only 20% of doctors now have even primitive EHRs and hospitals less than 10%, we wonder if this target date is realistic or simply another example of government arrogant overreach. We also worry about privacy and security issues and whether EHRs will become an instrument for electronic police action and federal compliance to the wishes of a ruling elite.

As a profession, we believe and have always believed in “patient-centered care.” That is what practicing medicine is all about. We agree with critics that that care could be better coordinated and less fragmented and that patients should have personal primary care physician or specialists practicing primary care, but we question whether achieving these goals requires federal legislation.

As a profession, we believe the current health system and its proposed reform will drive many doctors out of medicine and fail to attract sufficient numbers of new doctors. Current federal law to pay primary doctors more, to carry out tort reform, to expand the number of training programs, and to assure predictable payments for paying for doctors who care for those in federal programs are inadequate. We believe the new 32 million uninsured, and the 130,000 new Medicare patients entering the system each day in 2011, will simply overwhelm the ability of doctors to care for them and to stay in practice.

1 comment:

kevinh76 said...

Since when has central planning improved any system? Farms in Russia or China? As you stated, it is only the hubris of the planners that makes them think with enough rules and regulation they can somehow control things. I have not come to this conclusion without considerable thought but MEDICINE IS DIFFERENT!! It's different than banking and other forms of business in so many ways. It is personal, local, intimate. Just wait, once a critical mass of physicians withdraw from Medicare it will quickly become a tsunami and physicians will start fleeing en masse to free themselves from the intrusive regulation and constant second guessing. I wish they would implement the mandated SGR cuts so I would have a good excuse to do that right now. I think the AMA should take the same stand. They got rolled on HCR so they should stop being the mouse in the governments game of cat and mouse. Let them try to run their system when all the doctors have opted out.