Thursday, February 19, 2009

Words matter!

Any hope that the debate on health care reform might be conducted in a serious manner, without the fear-mongering seen in the early 1990s, may have been dashed by the rhetoric hurled at the heath programs in the economic stimulus bill.

Advocates across the ideological spectrum saw the stimulus bill as pre-cursor to the next big debate on health care reform.

For conservatives, it was viewed as the first skirmish in a battle against "government run" health care. For liberals, it was viewed as a "first step" toward using the power of government to guarantee universal coverage and "transform" the health care delivery system. For many of us in the middle, the ideological debate was strangely at odds with the actual substance of the legislation.

Conservative critics alleged that the health information technology and comparative effectiveness programs would lead to government rationing of health care. The Washington Times went so far as to compare these programs to Hitler's program to euthanize "elderly people with incurable diseases, young children who were critically disabled, and others who were deemed non-productive."

Yesterday, ACP's Chief Executive Officer, Dr. John Tooker, joined with his counterpart with the AARP, Mr. Bill Novelli, to take The Washington Times on for its "unconscionable" reference to Nazi Germany. These two CEOs, writing on behalf of the second largest physician membership organization and the largest consumer advocacy group in the United States, wrote that their members "would strongly oppose any attempt to limit any doctor or hospital from providing the best possible care to any patient. So it is especially galling that this editorial would present these two solutions as part of a plan to cut off care for older Americans."

Let's look at the facts. This is what the actual report language for the final House-Senate agreement says:

"The conferees do not intend for the comparative effectiveness research funding included in the agreement to be used to mandate coverage, reimbursement, or other policies for any public or private payer. The funding shall be used to conduct or support research to evaluate and compare the clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition. Conferees recognize that a 'one-size-fits all' approach to patient treatment is not the most medically appropriate solution to treating various conditions."

Not exactly the stuff of the National Socialist Party, is it?

It is not just the right that uses words to score ideological points. The left often says that health care is a right, but once something is defined as a right, it paints people who disagree as wanting to deny those same rights. This places people who have legitimate concern about the role of government in health care in the same category as, say, past generations who opposed a woman's right to vote or stood in the schoolhouse door.

Health care reform deserves a good debate, and there is plenty of room for spirited, informed, respectful and evidence-based disagreement on the role of government. But the public is not served when words are used to mislead on the issues, to create fear, or to demonize those who disagree with you.

Today's question: What do you think - can we get to a respectful and informed debate on health care that avoids rhetoric that seems more designed to create fear than bring light to the issues?


Jay Larson MD said...

The editorial in The Washington Times strengthens the argument that a little knowledge is a dangerous thing. The health care reform debate will definitely be spirited and yes rhetoric will be rampant. The U.S. will have 300 million ideas on how health care should be reformed. The fridge people (those who are more than 2 standard deviations beyond the norm) will be on the news yabbering about Armageddon from health care reform. Let’s face it, doom and gloom sells and is displayed like a fine buffet for the news junkies. It is my hope that those who will be the major players in health care reform have the determination and the knowledge to get it right.

Unknown said...

Healthcare reform is needed. Affordable healthcare is not a Republican or Democrat issue. It is the American issue. Health care affordability is essential and humane.
Efficiency means eliminate wasteful spending. Currently, healthplan is acting as middle man spending about 25 cents for every dollar collected on premium.
Either we eliminate the middle man system entirely or we want the government to exert more pressure on the healthplan organization to mandate at least 65% of their collected premium to be spent on direct patient care.
Government should NOT be running the healthplan. Government should privatize Medicare program and Government should regulate HMO better. Currently, patients and healthcare providers are being squeezed from both above and below.
Hung Nguyen MD, Los Angeles, CA

Unknown said...

Health Care reform is needed, BUT it can't be designed like the Medicaid program. If Government insurance is given to the uninsured and needy that is great, but if it is like Medicaid physicians will not accept it. Currently in my area, our group of specialist is the only group taking Medicaid. We lose $70 on every visit, and we are over whelmed with pre-authorization phone calls for medications, and filling out Title XIX for supplies etc.. If this is what are new government sponsored health care is going to be like, then it won't work. We do not live in a dictatorship, and you cannot mandate or force a private physician to take a bad health care coverage. More and more physicians are leaving practices or going to cash only "fee for service" or "boutique medicine" because of all the administrative "red tape" to get reimbursed. The Reimbursements are not covering the office over head costs either. We need to eliminate all the extra paper work, pre-authorizations and let physicians spend their time seeing patients. We need to set fair standard costs that reimburse for the doctors time, and office overhead, but are not inflated for the fact that most insurance companies do not pay the full amount charged. If all insurance companies paid 100% of the fair charges, then costs could be reduced which would make it more affordable for cash paying patients. Since we cannot discriminate and charge different amounts to different payers, we are stuck having high office visits because insurance companies only pay 10-50% of the bill, and then the cash patient gets saddled with the same prices and they have to pay the entire bill. There is something very wrong with that!