Friday, August 24, 2012

Interview with Unconventional Health Care Reformer
Keywords; Entitlement programs,  political conventions, health reform,  lower costs, health savings accounts,  health access, consumer cost-sharing
It is not difficult to be unconventional in the eyes of the world when your unconventional is but the convention of your set.
Somerset Maugham, MD, (1874-1965),  The Moon and Sixpence
Q: As the Republican and Democrat conventions approach, you claim to be unconventional in your thinking on health reform. 

Just how unconventional are you?
A:  Very.   I think unconventionally.  With either party, The  only thing I agree upon is that Obama and Romney have vastly different visions.
Q:  How different ?
A:  Obama says government should run the show. Romney says the market should.
Q: What’s your vision?
A: A little of both.  Government could define  the overall benefits , but the market should compete on the bid. 

Also untold stores should be told.
Q: And what are those untold stories?
A:  I’ll give the top six.
One, that open-ended entitlement programs in the U..S. and Europe and elsewhere, are unsustainable and a leading cause of the international recession.    Inevitably,  universal social welfare programs collapse because of overpromises and underdelivery of ehalth services..
Two, that universal coverage programs produce long waits for care, rationing, and poor results for cancer, heart disease, diabetes, and disabling joint diseases.
Three, that centralized government programs can’t anticipate or control or even distribute care at the level of the market and inevitably limit freedom of choice.
Four,  that in the U.S. the health care and medical industries are the most productive economic sector  in terms of employment and create positive rather than negative economic impacts for communities.
Five, that the Obamacare strategy of cutting hospital revenues and doctor incomes by 40% over the next ten years are a recipe for a huge health care access crisis in 2014 and 2015 with a massive doctor shortage.
Six, the only way to truly cut health costs is to have consumers and employees know and share some of the costs out of their own pocketbooks.  As Milton Freidman said,  “There is no such thing as a free lunch.” But there is something known as the third rail of American politics – touching the third rail, known as free entitlement programs, and getting electrocuted and run out of politics on the third rail.
Q:  So how do you avoid being electrocuted?
A:  By giving Americans the facts- that the end result of “free” entitlements is loss of individual freedoms and  the path to national bankruptcy.  Medicare and Medicare now contribute  47% of the national debt, and are on the way to 90% if left unchecked. Medicare and Medicaid will sooner or later crowd out equally  worthwhile uses of government money – like roads, bridges, education, and the military.
Q: What can doctors do about this?
·         We can point out adverse consequences of Obamacare.

·         We can acquaint ourselves with the true costs of care – like excess administrative expenses, brand name drugs rather than generics,  life style excesses and abuses, lack of timely preventive measures – and direct our patients towards lower-cost solutions.

·         We can lobby  for expansion of health savings accounts and we can pull out of 3rd party arrangements that increase our overhead, take time away from patients, and artificially increase costs.

·         We can tell the public, legislators, and reformer that we can no longer afford to care for Medicare and Medicaid patients, and will no longer accept new government program patients.

Q: But isn’t accepting needy government patients not only unconventional but unacceptable for a healing profession.  Doctors are supposed to altruistic – caring for the sick, the disabled, and the poor- regardless of ability to pay.
A: Tell that to our creditors, medical student loan collectors, and colleges where we want to send our children.
Q: And what should physicians tell the public?
A: Tell them the U.S. cane no longer afford open-ended entitlement programs that crowd out money for research, education, infrastructure, the military, and other social welfare programs.
Tell them you cannot afford to accept new government progams that do not pay enough to cover your overhead.
Tell them that they are going to have to share and know the true costs of care. 
Tell them they may have to forego or delay lifestyle and lifesaving procedures  like joint replacement, coronary stents and bypasses, bariatric surgeries, or pay for them out of their own pockets or out of their health savings accounts.
Q: Thank you for your unconventional thoughts on the eve of the political conventions.

Tweet: Reducing entitlement program costs isn't   come at politcal price of limited access and greater consumer costs.  

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