Saturday, July 18, 2009

The Party's Over

Up until now, we have seen some superficial co-operation among disparate interests over needed healthcare reform, but now the wheels seem to be coming of the bus. Republicans, conservative groups and some business organizations have begun accelerating efforts to derail legislation, by calling the Democratic proposals costly and dangerous experiments in "government-run" health care. Their main goal is to slow down the pace of the legislation in Congress in the hope of fomenting wider opposition. Sen. Jim DeMint (R-S.C.) has been quoted in the Washington Post as saying, "If we're able to stop Obama on this, it will be his Waterloo." "It will break him."

What we are talking about, of course, is regulation of the market, and figuring out how to cover all of our citizens. That is not "government-run" health care. In the many countries of Europe, for example, very few of them "run" the health care system, Great Britain being the notable exception. By trotting out their tired old stereotypes, I think that conservative activists are discrediting their cause, and depriving us of a real debate on substance.

The fact is that we already do have one "government-run" health care program", and that is Medicare. I will be the first to tell you that it does have faults, but it is highly rated by those it serves, and it is quite efficient in it's management, far more so that private plans are. So much for the evil, clumsy government.

We already have a dysfunctional healthcare mess for which we spend more than anyone else on the planet. The money we waste may not be a government tax, but we are paying it every time we buy a product made by a US firm or pay your insurance premium.

Tuesday, July 14, 2009

New US Surgeon General Choice Says a Lot!

President Obama has finally announced his choice for surgeon general, and it is Dr. Regina Benjamin, a 52-year-old family physician who has spent most of her career practicing in a Gulf Coast clinic in Alabama. She graduated from Xavier University of Louisiana in 1979, attended Morehouse School of Medicine from 1980 to 1982, and received a doctor of medicine degree from the University of Alabama at Birmingham in 1984. She completed residency training in family Medicine at the Medical Center of Central Georgia in 1987, where her medical training was paid for by the National Health Service Corps, under which medical students promise to work in areas with few doctors in exchange for free tuition. She has also earned a master's in business administration in 1991 from Tulane University.

I am hopeful that President Obama's choice of Dr. Benjamin is a clear indication of the direction he wants to take in health care reform. The fact that he chose a family physician, and not a corporate bureaucrat or medical school academician seems to say a lot about what he values!

Sunday, July 12, 2009

Mayo Clinic Principles of Health Care reform

I had an interesting experience this week when my friend, retired pathologist Dr. Bob Gibb, asked me to sit in with him on a group telephone call among alumni physicians trained at the Mayo Clinic. It seems that Mayo has decided to try and play a "convener role" in our national discussion of health policy, and this phone conference was part of an effort to spread their message and get the word out about what they believe is central to true health care reform. They have also developed a web site for the Mayo Health Policy Center.

On the call I learned that Mayo has 4 cornerstone principles that they believe must be included for meanigful reform:
  • Creating Value - do we actually improve health in a measurable way?
  • Coordinated Care - Mayo is an example of working together and not in silos
  • Payment Reform - provide incentives to coordinate care, improve outcomes and enhance patient decision making
  • Health Insurance for All- essential in order to share risk, and improve the health of entire populations.
Although they have nailed 4 needed elements, I would add two more principles that I believe are also essential for us here in the United States:
  • Choice - people want a choice of doctors, plans and hospitals when possible
  • Access -the Massachusetts experience makes it clear that "insurance for all" is a hollow accomplishment without enough primary care doctors to provide access to care!
During the call, there was a discussion of the thought behind the Mayo cornerstones which noted that they support the personal medical home as a way of achieving the principles, they do not believe that simply expanding Medicare is rational, since it does not address value, coordination and payment reform, and they do support some pilot projects to sort out the various ideas of how to manage the needed change.

Steven Pearlstein noted in a recent Washington Post article, "If we really want to fix America's overpriced and under-performing health-care system, what really matters is changing the ways doctors practice medicine, individually and collectively. Everything else -- mandate or no mandate, the tax treatment of health benefits, whether there's a "public plan" to compete against private health insurers -- is just tinkering at the margin." I could not agree more. In order to get there, however, we will need to pay physicians differently to coordinate care, and measure results. For this reason, payment reform is the most critical first step. Indeed, the results we are seeing today are just what our payment system is designed to produce! The American College of Physicians (ACP) 2006 report actually predicts the imminent collapse of primary care in the United States, due to the inadequate and dysfunctional payment policies of the government and other third party payers.

We have an historic opportunity to change course. Thanks to the Mayo Clinic for weighing in!