tag:blogger.com,1999:blog-5549090417652989159.post2402608025577597708..comments2023-03-31T09:08:57.615-05:00Comments on David Fisher, MD, MPH: Where President Obama is wrong about health care reformDavid Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-5549090417652989159.post-59292877126243527992009-07-17T15:39:02.935-05:002009-07-17T15:39:02.935-05:00Tim,
I am not suggesting that we shut anyone out o...Tim,<br />I am not suggesting that we shut anyone out of health care. I simply balk at the idea that a centralized, government-run health care system will be able to solve the problem of people not having access to health care. There will always be limited resources. There will never be enough health care to go around. I reject the idea that offering "health insurance to all people" will somehow reduce the gap between "haves" and "have nots". If anything, the gap will increase. I expect the government option will have very limited access to any type of quality health care. I hope I am wrong, but I watch the way large beauracracies work and I doubt severely that Washington can swoop in and offer quality health care to however many million Americans when they have already bloated the costs of Medicare and Medicaid. What we will end up with, then, are those who can afford to pay for private health care, and those who have to settle for the government option. Having "health insurance" does not guarantee health care. I liken the public option to the low rate auto insurance companies that give drivers a policy just so they can stay within the law, but rarely pay out on any actual claims. It seems we are so caught up in this idea that everyone needs "coverage" that we are willing to do whatever it takes to slap a label on all the uninsured just so we can say they are now insured. In doing so, I fear we will draw more resources away from an already struggling industry and put those resources into more and more wasteful processes. I also fear centralizing the power of health care decisions into one overseeing group, as President Obama promised to do today. The potential for corruption is unavoidable, and health care decisions will not be made between doctor and patient, but rather by committees that are using "utilization" and "cost control" and their guiding lights in making those decisions. If that could be done in a pure manner, it would not be so bad, but a swarm of lobbyists will surround these committees offering favors for approval of a drug or treatment, because the stakes are now even higher since millions more people's health care decisions will be influenced by this small but very powerful oversight committee. Again, I believe that President Obama wants things to get better, I just fear that a centralized approach is nothing more than a way to bring more power to Washington, to be able to claim that we "insured" all America, while actually causing damage to the quality of health care that we all enjoy in this country to varying degrees.David Fisher, MD, MPHhttps://www.blogger.com/profile/06815008637271967993noreply@blogger.comtag:blogger.com,1999:blog-5549090417652989159.post-15162102626932416032009-07-01T00:08:24.443-05:002009-07-01T00:08:24.443-05:00I thank you also for trying to explain this comple...I thank you also for trying to explain this complex issue to the laymen. There is much that I still don't comprehend enough to be certain if I agree or disagree. I know how frustrating it is as an educator to have people who clearly haven't spent time recently in the classroom making educational policy or paperwork requirements that keep me from actually teaching. <br />However, at the risk of arrogance I still have many questions. Do you think that we have to choose between quality health care and universal access to health care? Although we may be the "envy of the world" as far as the quality of our doctors and ability to do advanced procedures, I think the actual health statistics of Americans fall well below many other industralized nations. A significant cause of this may be that many American do not have access to quality health care because of its skyrocketing cost. Are we destined to be a nation of health care "haves" and "have nots" as health insurance rates show no sign of halting in their staggering increases? Perhaps Obama is wrong in some of his tactics in creating health care reform. But are there means by which we may decrease significantly the estimated 47 million people who are uninsured? Or is it a necessary evil that many families be shut out of the health care system so that a competetive environment that encourages innovation will ensue? Is there a third stream of reform that will allow more people access but still retain a competetive, nonstifling environment? Is the situation either / or?Tim Boveynoreply@blogger.comtag:blogger.com,1999:blog-5549090417652989159.post-6466228066929473562009-06-27T19:26:59.841-05:002009-06-27T19:26:59.841-05:00Hi Doctor Dave,
Thank you so much for taking thi...Hi Doctor Dave, <br /><br />Thank you so much for taking this complex issue and breaking it down so that the average, non-medical person can understand what is at stake. I plan to refer many people to this article. <br /><br />Thanks <br /><br />Joan BishopAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5549090417652989159.post-64114631097501144122009-06-26T22:58:10.060-05:002009-06-26T22:58:10.060-05:00Anonymous doc, I agree. Thanks for your comment.
...Anonymous doc, I agree. Thanks for your comment.<br />There is no doubt that doctors are forced to drive up costs by practicing "defensive" medicine. We all do it, even subconsciously, because we hear the lawsuit horror stories and see the ads on TV by the predatory law practices.<br />Another policy that I think should be part of tort reform is the opportunity for doctors to countersue for damages when they face a frivolous lawsuit. As you know, even if we win the case and are completely absolved of negligence, the fact that we were sued at all will always remain on our record and will drive up our malpractice rates.David Fisher, MD, MPHhttps://www.blogger.com/profile/06815008637271967993noreply@blogger.comtag:blogger.com,1999:blog-5549090417652989159.post-41480520694091391302009-06-26T22:16:49.857-05:002009-06-26T22:16:49.857-05:00Hey Doc, I am also a geriatrician and FP doc. I ha...Hey Doc, I am also a geriatrician and FP doc. I have been really disappointed with Obama because he does not support a cap on non economic damages. He is no friend. I have been excited about most of his health care reform until he said that at the AMA meeting. Now I have lost faith in him, and he became an uncaring SOB. It was that crack that shattered my image of him. I personally think that he will not succeed. Historically the AMA has been able to shut down any large reform that is not in the best interests of American Medicine. I am not a member of the AMA because I can't afford it. The AMA has good intentions but has screwed up in the past in health care reform. In the 70s Nixon and Ted Kennedy both agreed that HMOs were a good thing -- and they were because at that time HMOs were "Staff Models" they employed physicians and hospitals. The AMA forced a provision for IPAs which allowed insurance companies to take premiums and divide up cap payments giving some to doctors and some to hospitals. When you do not have the whole structure of the staff model HMO, in effect you cause doctors to be at risk for patients debts, and this did put physicians out of business. I see no justification for unlimited damages when a we have a legal climate that lets a judge file a lawsuit againts a cleaning business for millions because they damaged his pants.Anonymousnoreply@blogger.com