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David Fisher, MD, MPH: More thoughts on health care reform

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Tuesday, July 21, 2009

More thoughts on health care reform

I am not an economist; I do not claim to understand the complexities of the health care market, nor can I accurately predict how the proposed health care legislation will impact our nation's health care industry. However, many aspects of the proposed reforms make me uneasy.


1) Creating a centralized oversight committee in Washington puts too much power in one place. This group of doctors and other professionals will be making decisions about what treatment or procedure is appropriate for what person at what age or stage of their illness. Those decisions should remain between you and your doctor, not a committee in Washington. Further, many of the decisions will inevitably be made for political rather than medical reasons, as swarms of lobbyists and special interest groups will exert their influence over this committee to obtain results that benefit their own self-interest instead of the patient's. Imagine, for example, the frenzied efforts of drug companies to sway the government-approved formulary to choose their medication over their competitor's. Billions of dollars and tens of thousands of jobs could be at stake. Such far-reaching power over the industry will lead to corruption, no matter how well-intentioned the President or his oversight committee may be.

2) Like it or not, health care is a business. That cannot be changed, and attempting to change it will lead to laziness and stifled creativity. The most successful businesses succeed because they provide their services better than anyone else. In a market system, a business cannot survive unless it stays one step ahead of its competitors. Incredible innovations in health care technology and health care delivery have come from the opportunity to compete and succeed in a competitive market. Introducing more government-supported players into the market will dilute creativity and distort the field of innovation. Private health care companies must provide quality health care within a limited cost, or they go out of business. A universal government health plan has no survival accountability; if it fails to control costs or deliver quality services, it can simply be bailed out with more tax dollars. There will be no real consequences for poor performance, and therefore, I fear that the federal government's health care bureaucracy will become more and more bloated and eventually crowd out private health care companies that have to play by the tougher rules of a free market. Furthermore, competition among health care providers is the factor most responsible for the high level of patient satisfaction that exists in this nation (I believe our system needs reform, but I also believe that claims of imminent collapse and widespread dissatisfaction with our system are vastly overstated for political gain). One of the leading indicators being looked at by doctors, hospitals, and insurance companies is patient satisfaction. This is because patients can, for the most part, choose who will provide their health care. I believe the proposed reforms, despite President Obama's promises to preserve choice, will actually limit patient's choices, and the health care industry will begin to care less and less about patient satisfaction when their clientele no longer have the option of going to the doctor across the street if they are dissatisfied.

3) While I do not think tort reform would answer all of our health care problems, leading experts from diverse political backgrounds agree that the medical malpractice industry is draining resources from our health care system. Yet, no attempt was made in the proposed reform to address this issue. If we are really trying to control costs by any means, shouldn't tort reform be part of a broad health care reform package?

Though I have not read the 1000 page House bill, I will say that I am encouraged in hearing about increased funding for Federally Qualified Health Care centers that provide much of the health care in areas stricken by poverty. I am also encouraged by the proposal's promise to redirect resources toward prevention and primary care. Even so, I think the overall philosophy of increasing government's involvement in health care will have disastrous results.

As an alternative, I have read much of Senator Tom Coburn's proposed plan, and I agree with much of it. He is a physician and he understands the importance of preserving the doctor-patient relationship, something I think the President's plan will damage even further. Sen. Coburn also understands the value of having doctors and insurance companies compete for patients, and attempts to preserve that dynamic in his plan. Links to the entire bill or a summary can be found here.

It will be interesting to see how this unfolds and I would love to hear what you think.

2 comments:

mama said...

Hey there!

One thing that caught my eye was your concern that UHC will cause a group of people in Washington to make decisions that should be between patient and doctor. Isn't that already the case with typical health insurance? I mean, insurance companies right now only allow payment for certain services, they decide what is considered reasonable and customary, etc...

I am very glad you posted about this, David - I am going to read more about the Patient's choice act.

The other thing that jumped out at me when I just skimmed the patients choice act was this...

"Each year, five chronic diseases (heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes)
cause two‐thirds of American deaths; treatment of these largely preventable diseases makes up 75 percent of total
health care expenditures"

I really they had sepcified Type 2 diabetes, because Type 1 is an automimmune disease, and about as preventable as MS. It's frustrating that people don't understand or recognize the difference :(

Thanks for the blog! Will be watching closely for more information.

mama said...

Okay one other question -

after reading this

"• Providing an advanceable and refundable tax credit of $2,300 per individual or $5,700 per family" I am concerned because I don't think I would be able to find insurance for that amount because of preexisting conditions. Is there something in the bill that forces insurance companies to keep the premiums the same no matter what one's health status is? Otherwise, I am afraid the people who really need insurance (sick people) still wouldn't be able to afford it. That's part of the problem right now - if one has an expensive to treat preexisting condition (like diabetes) the cost of individual health insurance is astronomical! Do you have any insight into this problem?